Provider Demographics
NPI:1154329621
Name:REINER, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:REINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E OCEAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7076
Mailing Address - Country:US
Mailing Address - Phone:805-735-3391
Mailing Address - Fax:805-736-3081
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7076
Practice Address - Country:US
Practice Address - Phone:805-735-3391
Practice Address - Fax:805-736-3081
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-05-22
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
CAA30004208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A300040Medicaid
CA953410303OtherBLUE SHIELD
CAB50120Medicare UPIN
CA00A300040Medicaid