Provider Demographics
NPI:1922106475
Name:REINOSO, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:REINOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2809
Mailing Address - Country:US
Mailing Address - Phone:805-652-5018
Mailing Address - Fax:805-648-6170
Practice Address - Street 1:147 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2809
Practice Address - Country:US
Practice Address - Phone:805-652-5018
Practice Address - Fax:805-648-6170
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77260146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050394OtherBLUE CROSS
CA95-1683892OtherOTHER INSURANCE
CAZZZA56032OtherBLUE SHIELD
CAZZZ53994ZOtherBLUE SHIELD
CAHSC30394FMedicaid
CAZZT40394FMedicaid
CAG77260OtherLICENSE NUMBER
CA95-1683892OtherOTHER INSURANCE
CA050394Medicare ID - Type UnspecifiedMEDICARE ACUTE CMH
CA050394OtherBLUE CROSS