Provider Demographics
NPI:1285615955
Name:ROLAND D REINHART M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ROLAND D REINHART M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-341-2360
Mailing Address - Street 1:PO BOX 14170
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92255-4170
Mailing Address - Country:US
Mailing Address - Phone:760-341-2360
Mailing Address - Fax:760-346-5940
Practice Address - Street 1:39800 PORTOLA AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-0620
Practice Address - Country:US
Practice Address - Phone:760-341-2360
Practice Address - Fax:760-346-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49097208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ4857OtherMC RAIL ROAD GROUP #
CAZZZ21538ZMedicare PIN