Healthcare Provider Details

I. General information

NPI: 1932295441
Provider Name (Legal Business Name): RICHARD C. REZNICHEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST HARBOR-UCLA MED. CTR., BOX 5
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST HARBOR-UCLA MED. CTR., BOX 5
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2724
  • Fax: 310-222-2856
Mailing address:
  • Phone: 310-222-2724
  • Fax: 310-222-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG11349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: