=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891776258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES FRANCIS REILLY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2005
-----------------------------------------------------
Last Update Date | 02/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1808 VERDUGO BLVD 209
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91208-1477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-949-4494
-----------------------------------------------------
Fax | 818-949-7330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1808 VERDUGO BLVD 209
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91208-1477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-949-4494
-----------------------------------------------------
Fax | 818-949-7330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G51287
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | G51287
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------