1205929932 NPI number — MRS. MARNI LYNN BREGMAN REINHARDT

Table of content: MRS. MARNI LYNN BREGMAN REINHARDT (NPI 1205929932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205929932 NPI number — MRS. MARNI LYNN BREGMAN REINHARDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINHARDT
Provider First Name:
MARNI
Provider Middle Name:
LYNN BREGMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205929932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 BRISTOL ST N
Provider Second Line Business Mailing Address:
SUITE 245B
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-484-5240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 BRISTOL ST N
Provider Second Line Business Practice Location Address:
SUITE 245B
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-484-5240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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