Healthcare Provider Details

I. General information

NPI: 1811459043
Provider Name (Legal Business Name): KARI JORDAN REZAC DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 DONNER PASS RD
TRUCKEE CA
96161-4812
US

IV. Provider business mailing address

10710 DONNER PASS RD
TRUCKEE CA
96161-4812
US

V. Phone/Fax

Practice location:
  • Phone: 530-582-7488
  • Fax:
Mailing address:
  • Phone: 530-582-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A21020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: