Healthcare Provider Details

I. General information

NPI: 1548365083
Provider Name (Legal Business Name): DR. DEBRA ANN REINKING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

IV. Provider business mailing address

700 IRWIN ST #102
SAN RAFAEL CA
94901-3339
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-5992
  • Fax:
Mailing address:
  • Phone: 415-460-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA43867
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: