Healthcare Provider Details

I. General information

NPI: 1649290248
Provider Name (Legal Business Name): KAREN LYNN RECKAMP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN LYNN RIEDL MD

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. DUARTE RD
DUARTE CA
91010
US

IV. Provider business mailing address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-8111
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-218-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA75041
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA75041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: