1326130840 NPI number — MRS. TERRY ANN REIMANN M.D.

Table of content: MRS. TERRY ANN REIMANN M.D. (NPI 1326130840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326130840 NPI number — MRS. TERRY ANN REIMANN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIMANN
Provider First Name:
TERRY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1326130840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4655 VISTA DE ORO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-704-9034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5620 WILBUR
Provider Second Line Business Practice Location Address:
AVE
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-345-0601
Provider Business Practice Location Address Fax Number:
818-345-2061
Provider Enumeration Date:
09/29/2006

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: 207R00000X , with the licence number:  G41999 , 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: 00G419990 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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