Provider Demographics
NPI:1457469041
Name:REINKE, KARA ANN
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:ANN
Last Name:REINKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:
Practice Address - Street 1:4725 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4715
Practice Address - Country:US
Practice Address - Phone:619-515-2560
Practice Address - Fax:619-263-2499
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79861207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06670ZOtherDERMATOLOGY CONSULTANTS OF MARIN, INC. GROUP PIN
CAA79861OtherMEDICAL LICENSE
CAZZZ06670ZOtherDERMATOLOGY CONSULTANTS OF MARIN, INC. GROUP PIN
CA00A798610Medicare PIN