Healthcare Provider Details

I. General information

NPI: 1770780462
Provider Name (Legal Business Name): WENDY LEIGH REULMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY #210
ALISO VIEJO CA
92656-5336
US

IV. Provider business mailing address

5 JOURNEY #210
ALISO VIEJO CA
92656-5336
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-7122
  • Fax: 949-305-7160
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: