Provider Demographics
NPI:1336190354
Name:REUSS, KAREN L (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:REUSS
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 1:27762 ANTONIO PKWY
Mailing Address - Street 2:L1-418
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1140
Mailing Address - Country:US
Mailing Address - Phone:949-922-9410
Mailing Address - Fax:949-472-4371
Practice Address - Street 1:24401 CALLE DE LA LOUISA
Practice Address - Street 2:SUITE #200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3623
Practice Address - Country:US
Practice Address - Phone:949-452-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG745932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G745930OtherBLUE SHIELD
CA00G745930Medicaid
WG74593KMedicare ID - Type Unspecified
CA00G745930OtherBLUE SHIELD
CA00G745930Medicaid