MEDICARE: NINA CHRISTINE REYNOLDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1760047930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA CHRISTINE REYNOLDS

Provider Business Mailing Address
First Line	:	2901 W COAST HWY STE 150
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4030
Country	:	US
Telephone Number	:	949-650-7267
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 E WEST VIEW DR
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-4315
Country	:	US
Telephone Number	:	714-322-8339
Fax Number	:

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

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	08/14/2024

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