Provider Demographics
NPI:1063036465
Name:REINER, AMANDA JO (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:REINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ROWLAND WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5054
Mailing Address - Country:US
Mailing Address - Phone:415-897-9664
Mailing Address - Fax:
Practice Address - Street 1:75 ROWLAND WAY STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5054
Practice Address - Country:US
Practice Address - Phone:415-897-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU1113207Q00000X
TXBP10071558390200000X
CA20A23066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program