=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366783649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY M. REINSTADLER, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2013
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 361 HOSPITAL RD STE 533
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-200-9667
-----------------------------------------------------
Fax | 949-200-9498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 361 HOSPITAL RD STE 533
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92663-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-200-9667
-----------------------------------------------------
Fax | 949-200-9498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMY MARIE REINSTADLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-200-9667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | A109147
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------