Provider Demographics
NPI:1780471128
Name:KOENIG, RESHMA RE
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:RE
Last Name:KOENIG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14021 RANCHERO DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-8351
Mailing Address - Country:US
Mailing Address - Phone:951-300-3285
Mailing Address - Fax:
Practice Address - Street 1:14021 RANCHERO DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-8351
Practice Address - Country:US
Practice Address - Phone:951-300-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020591363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care