Healthcare Provider Details

I. General information

NPI: 1295507754
Provider Name (Legal Business Name): VIRGINIA IRENE REISING LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

1355 S PERRIS BLVD APT 34
PERRIS CA
92570-2552
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 951-623-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number277962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: