Healthcare Provider Details

I. General information

NPI: 1679097612
Provider Name (Legal Business Name): DR. PRISCILLA M REINICKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRISCILLA MENDEZ MS

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 GATEWAY BLVD
FAIRFIELD CA
94533-6900
US

IV. Provider business mailing address

1550 GATEWAY BLVD
FAIRFIELD CA
94533-6901
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-4000
  • Fax:
Mailing address:
  • Phone: 707-421-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: