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General NPI Number Information
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NPI Number | 1396951828
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Entity Type | Individual
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Provider Name | PAUL FRANCIS REARDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15 CORPORATE PLAZA DR SUITE 140
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7918
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Country | US
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Telephone | 949-759-7776
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Fax | 949-717-6412
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Provider Business Mailing Address
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Address Line | 15 CORPORATE PLAZA DR SUITE 140
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7918
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Country | US
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Telephone | 949-759-7776
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Fax | 949-717-6412
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A49699
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License Number State | CA
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