MEDICARE: DR. WILLIAM M REYNOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY26015	CA

General Provider Information

NPI Number	:	1154782167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM M REYNOLDS

Provider Business Mailing Address
First Line	:	3294 ROYAL DR
Second Line	:	STE 13
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8500
Country	:	US
Telephone Number	:	415-218-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 IRVING ST.
Second Line	:	PMB 321
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122
Country	:	US
Telephone Number	:	415-218-3850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	09/16/2016

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