Healthcare Provider Details

I. General information

NPI: 1477518520
Provider Name (Legal Business Name): RICHARD J REYNOLDS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25109 JEFFERSON AVE STE 100
MURRIETA CA
92562-8117
US

IV. Provider business mailing address

1545 W FLORIDA AVE
HEMET CA
92543-3814
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-0440
  • Fax: 888-694-7606
Mailing address:
  • Phone: 951-791-1111
  • Fax: 888-856-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC36017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: