Provider Demographics
NPI:1659376689
Name:REZNICK, JAMES WARREN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WARREN
Last Name:REZNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5311
Mailing Address - Country:US
Mailing Address - Phone:833-242-0100
Mailing Address - Fax:
Practice Address - Street 1:611 LIDO PARK DR APT 6A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4407
Practice Address - Country:US
Practice Address - Phone:949-689-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007666207R00000X
CA20A6509207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine