Healthcare Provider Details

I. General information

NPI: 1942880349
Provider Name (Legal Business Name): JACOB REZNIK MD AND ALENA REZNIK MD A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE STE 302
NEWPORT BEACH CA
92660-7787
US

IV. Provider business mailing address

1401 AVOCADO AVE STE 302
NEWPORT BEACH CA
92660-7787
US

V. Phone/Fax

Practice location:
  • Phone: 310-980-6038
  • Fax: 949-335-6512
Mailing address:
  • Phone: 310-980-6038
  • Fax: 949-335-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: ALENA REZNIK
Title or Position: MANAGER
Credential: MD
Phone: 310-980-6038