Provider Demographics
NPI:1942510698
Name:REEVES, LAURIE ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANNE
Last Name:REEVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6367 ALVARDO CT.
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-583-1954
Mailing Address - Fax:619-583-2875
Practice Address - Street 1:6367 ALVARDO CT.
Practice Address - Street 2:SUITE #200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-583-1954
Practice Address - Fax:619-583-2875
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21252363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical