Healthcare Provider Details

I. General information

NPI: 1568596740
Provider Name (Legal Business Name): REYNOLDS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 W ROSS AVE
ALHAMBRA CA
91803-2546
US

IV. Provider business mailing address

2925 W ROSS AVE
ALHAMBRA CA
91803-2546
US

V. Phone/Fax

Practice location:
  • Phone: 760-898-3131
  • Fax:
Mailing address:
  • Phone: 760-898-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC43190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberC43190
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC43190
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC43190
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS F REYNOLDS
Title or Position: OWNER
Credential: MD
Phone: 760-898-3131