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General NPI Number Information
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NPI Number | 1184785404
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Entity Type | Individual
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Provider Name | SUSAN FOSTER REYNOLDS MD
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 652 JACON WAY
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-2827
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Country | US
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Telephone | 800-361-5321
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Fax | 310-454-4933
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Provider Business Mailing Address
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Address Line | 652 JACON WAY
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-2827
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Country | US
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Telephone | 310-454-4933
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Fax | 310-454-5934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G34506
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License Number State | CA
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