Provider Demographics
NPI:1710936976
Name:RICE, REGINALD DIETEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:DIETEL
Last Name:RICE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-344-2000
Mailing Address - Fax:530-344-2014
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-2000
Practice Address - Fax:530-344-2014
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-01-12
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Provider Licenses
StateLicense IDTaxonomies
CAG70357207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G703570OtherSTATE PHYSICIAN LICENSE #
CAF51415Medicare UPIN
CAF51415Medicare UPIN