Provider Demographics
NPI:1568424521
Name:REINGOLD, JACK (DPM)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:REINGOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 DEVONSHIRE DR
Mailing Address - Street 2:F
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5136
Mailing Address - Country:US
Mailing Address - Phone:760-942-1890
Mailing Address - Fax:760-942-1895
Practice Address - Street 1:1011 DEVONSHIRE DR STE F
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5136
Practice Address - Country:US
Practice Address - Phone:760-942-1890
Practice Address - Fax:760-942-1895
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2538213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480032777OtherRR INDIVIDUAL PROV. #
CA480032777OtherRR INDIVIDUAL PROV. #
CACB239855Medicare PIN
CAWE2538AMedicare PIN