Healthcare Provider Details

I. General information

NPI: 1891776258
Provider Name (Legal Business Name): JAMES FRANCIS REILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD 209
GLENDALE CA
91208-1477
US

IV. Provider business mailing address

1808 VERDUGO BLVD 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 TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG51287
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberG51287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: