Healthcare Provider Details

I. General information

NPI: 1164064408
Provider Name (Legal Business Name): MR. JOHN KNISER REINHART I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E HUENEME RD
OXNARD CA
93033-8615
US

IV. Provider business mailing address

1531 E HUENEME RD
OXNARD CA
93033-8615
US

V. Phone/Fax

Practice location:
  • Phone: 707-803-7087
  • Fax:
Mailing address:
  • Phone: 707-803-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5430-1
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: