Provider Demographics
NPI:1184785404
Name:REYNOLDS, SUSAN FOSTER (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FOSTER
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 JACON WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2827
Mailing Address - Country:US
Mailing Address - Phone:310-454-4933
Mailing Address - Fax:310-454-5934
Practice Address - Street 1:652 JACON WAY
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2827
Practice Address - Country:US
Practice Address - Phone:800-361-5321
Practice Address - Fax:310-454-4933
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34506207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine