1356454698 NPI number — MRS. LIZA HOEN REICHENBERGER PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356454698 NPI number — MRS. LIZA HOEN REICHENBERGER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICHENBERGER
Provider First Name:
LIZA
Provider Middle Name:
HOEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOEN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
PAULINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356454698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 AVILA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94402-2852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-454-9951
Provider Business Mailing Address Fax Number:
650-350-1228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 WHIPPLE AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94062-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-365-5996
Provider Business Practice Location Address Fax Number:
650-365-0655
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  002934 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA19934 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100001887A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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