MEDICARE: JAMES WARREN REZNICK DO

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	207R00000X	Internal Medicine Physician	007666	AZ
2	207RC0000X	Cardiovascular Disease Physician	20A6509	CA

General Provider Information

NPI Number	:	1659376689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WARREN REZNICK DO

Provider Business Mailing Address
First Line	:	6739 W CACTUS RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-5311
Country	:	US
Telephone Number	:	833-242-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 LIDO PARK DR APT 6A
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4407
Country	:	US
Telephone Number	:	949-689-2231
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/04/2022

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