Provider Demographics
NPI:1992794176
Name:REICH, DANIEL S (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:REICH
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 1:801 N TUSTIN AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3601
Mailing Address - Country:US
Mailing Address - Phone:714-543-4880
Mailing Address - Fax:714-543-4883
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:STE 306
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3601
Practice Address - Country:US
Practice Address - Phone:714-543-4880
Practice Address - Fax:714-543-4883
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA300160207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A300160Medicaid
CAA25942Medicare UPIN
CAA25942Medicare PIN