Healthcare Provider Details

I. General information

NPI: 1154372449
Provider Name (Legal Business Name): VICTOR I. REUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARNASSUS AVE
SAN FRANCISCO CA
94143-2211
US

IV. Provider business mailing address

1635 DIVISADERO STREET, SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7478
  • Fax: 415-476-7404
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG31811
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberG31811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: