Healthcare Provider Details

I. General information

NPI: 1902180656
Provider Name (Legal Business Name): HILARY KRISTIN REZNICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S DOBSON RD ST 200
CHANDLER AZ
85224-5680
US

IV. Provider business mailing address

725 S DOBSON RD ST 200
CHANDLER AZ
85224-5680
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-7546
  • Fax: 480-899-7599
Mailing address:
  • Phone: 480-899-7546
  • Fax: 480-899-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: