Healthcare Provider Details

I. General information

NPI: 1154397644
Provider Name (Legal Business Name): BARBARA G. REISMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CALIFORNIA DR
YOUNTVILLE CA
94599-1412
US

IV. Provider business mailing address

PO BOX 942895
SACRAMENTO CA
94295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4772
  • Fax: 707-944-5052
Mailing address:
  • Phone: 916-653-0080
  • Fax: 916-653-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG74762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: