Provider Demographics
NPI:1659561710
Name:REYNOLDS, NAOMI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 STANISLAUS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2464
Mailing Address - Country:US
Mailing Address - Phone:209-869-0131
Mailing Address - Fax:
Practice Address - Street 1:3227 STANISLAUS ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2464
Practice Address - Country:US
Practice Address - Phone:209-869-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice