Healthcare Provider Details

I. General information

NPI: 1013320175
Provider Name (Legal Business Name): JOELLE REYNARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BUILDING 1A, ROOM 1009
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5239
  • Fax:
Mailing address:
  • Phone: 714-456-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number143122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: