Individual provider Active NPI

Kristina Sandler Reynosa

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1407513898
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
157674 Issued in CA
Practice address
4520 Executive Dr Ste 225
San Diego, CA 92121-3094
Phone
(858) 202-1822
NPI assigned
Nov 21, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 126747 CA
Marriage & Family Therapist 106H00000X 157674 CA Primary

Addresses

Primary practice location

4520 Executive Dr Ste 225
San Diego, CA 92121-3094

Mailing address

5665 Friars Rd Unit 260
San Diego, CA 92110-2558

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251112003997 CA Practitioner - Marriage and Family Therapist 7113418641 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
126747CAMDMarriage & Family Therapist
157674CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Marriage & Family Therapist CurrentSince Oct 1, 2025 Accepting new patients
Roybal MD Chemical Dependence Treatment Inc PastSince Nov 28, 2021 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1407513898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 FRIARS RD UNIT 260",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921102558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 EXECUTIVE DR STE 225",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213094",
            "telephone_number": "858-202-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOSA",
        "first_name": "KRISTINA",
        "middle_name": "SANDLER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-21",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "126747",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "157674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.