Provider Demographics
NPI:1639518335
Name:REZNICEK, DONALD (L AC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:REZNICEK
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CINNAMON TEAL LN
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6611
Mailing Address - Country:US
Mailing Address - Phone:415-846-1238
Mailing Address - Fax:
Practice Address - Street 1:1165 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1041
Practice Address - Country:US
Practice Address - Phone:415-846-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist