Healthcare Provider Details

I. General information

NPI: 1669581716
Provider Name (Legal Business Name): JAMES REILLY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD SUITE 209
GLENDALE CA
91208-1477
US

IV. Provider business mailing address

1808 VERDUGO BLVD SUITE 209
GLENDALE CA
91208-1477
US

V. Phone/Fax

Practice location:
  • Phone: 818-949-4494
  • Fax: 818-949-7330
Mailing address:
  • Phone: 818-949-4494
  • Fax: 818-949-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG51287
License Number StateCA

VIII. Authorized Official

Name: JAMES FRANCIS REILLY
Title or Position: OWNER
Credential: M.D.
Phone: 818-949-4494