Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 143122 | CA |
NPI | 1013320175 |
---|---|
Provider Name | Joelle Reynard |
First Address | Orange, CA 92868-3201 |
Second Address | Orange, CA 92868-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2014 |
Last Update Date | 23/12/2021 |