Provider Demographics
NPI:1053479469
Name:REISER, PAUL JAMES
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:REISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 DIVISION ST
Mailing Address - Street 2:KAISER PERMANENTE SUITE 100
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3333
Mailing Address - Country:US
Mailing Address - Phone:707-645-2700
Mailing Address - Fax:707-645-2181
Practice Address - Street 1:1141 DIVISION ST
Practice Address - Street 2:KAISER PERMANENTE SUITE 100
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3333
Practice Address - Country:US
Practice Address - Phone:707-645-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical