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NPI Code Detail

MEDICARE: PAUL A REISCH MD

MEDICARE: PAUL A REISCH MD
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
12085R0202XDiagnostic Radiology PhysicianG80478CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G804780OTHERCAMEDI CAL

General Provider Information

NPI Number : 1871576363
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL A REISCH MD
Provider Business Mailing Address
First Line : 1798 N GAREY AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-2918
Country : US
Telephone Number : 909-865-9537
Fax Number : 909-397-0194
Provider Business Practice Location Address
First Line : 1798 N GAREY AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-2918
Country : US
Telephone Number : 909-865-9537
Fax Number : 909-397-0194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 08/01/2007

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Directions to “ PAUL A REISCH MD” Practice Location

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