Provider Demographics
NPI:1710429857
Name:RELIANT MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:RELIANT MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:DAUDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-330-4259
Mailing Address - Street 1:4944 WINDPLAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9688
Mailing Address - Country:US
Mailing Address - Phone:916-330-4259
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2574
Practice Address - Country:US
Practice Address - Phone:916-330-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95421207V00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty