Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G70357 | CA |
NPI | 1710936976 |
---|---|
Provider Name | Dr. Reginald Dietel Rice JR. |
First Address | San Francisco, CA 94145-0680 |
Second Address | Placerville, CA 95667-6278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 12/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G703570 | STATE PHYSICIAN LICENSE # (01) | CA |
F51415 | (02) | CA |