MEDICARE: SARA JAMIE REINGANUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G70642	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083647523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JAMIE REINGANUM MD

Provider Business Mailing Address
First Line	:	13847 EAST 14TH STREET
Second Line	:	SUITE 109
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2625
Country	:	US
Telephone Number	:	510-357-7141
Fax Number	:	510-357-4274

Provider Business Practice Location Address
First Line	:	13847 EAST 14TH STREET
Second Line	:	SUITE 109
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2625
Country	:	US
Telephone Number	:	510-357-7141
Fax Number	:	510-357-4274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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