MEDICARE: VALERIE JENINE REILLY P.A.

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	363A00000X	Physician Assistant	PA15225	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588655617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE JENINE REILLY P.A.

Provider Business Mailing Address
First Line	:	699 W TEFFT ST
Second Line	:	SUITE A
City	:	NIPOMO
State	:	CA
Zip	:	93444-9289
Country	:	US
Telephone Number	:	805-930-9995
Fax Number	:	805-929-5771

Provider Business Practice Location Address
First Line	:	699 W TEFFT ST
Second Line	:	SUITE A
City	:	NIPOMO
State	:	CA
Zip	:	93444-9289
Country	:	US
Telephone Number	:	805-930-9995
Fax Number	:	805-929-5771

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	01/26/2017

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