Healthcare Provider Details

I. General information

NPI: 1730126277
Provider Name (Legal Business Name): REINHILD ELISABETH AYOUB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REINHILD ELISABETH NAUMANN

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 1ST AVE SW
CASTLE ROCK WA
98611
US

IV. Provider business mailing address

139 1ST AVE SW
CASTLE ROCK WA
98611
US

V. Phone/Fax

Practice location:
  • Phone: 360-274-6349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00026734
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: