Provider Demographics
NPI:1578863932
Name:WILLIAM F. REYNOLDS, M.D., INC.
Entity Type:Organization
Organization Name:WILLIAM F. REYNOLDS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-790-1278
Mailing Address - Street 1:1808 VERDUGO BLVD.
Mailing Address - Street 2:SUITE 318
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1464
Mailing Address - Country:US
Mailing Address - Phone:818-790-1278
Mailing Address - Fax:818-952-0134
Practice Address - Street 1:1808 VERDUGO BLVD.
Practice Address - Street 2:SUITE 318
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1464
Practice Address - Country:US
Practice Address - Phone:818-790-1278
Practice Address - Fax:818-952-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25324261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A253240Medicaid
A25324Medicare PIN
A24382Medicare UPIN