Provider Demographics
NPI:1396537783
Name:REISNER HEALTH CENTER PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:REISNER HEALTH CENTER PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARAMO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-495-0005
Mailing Address - Street 1:43824 20TH ST W # 2281
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5201
Mailing Address - Country:US
Mailing Address - Phone:661-495-0005
Mailing Address - Fax:800-890-6055
Practice Address - Street 1:43807 10TH ST W STE A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4805
Practice Address - Country:US
Practice Address - Phone:661-418-0060
Practice Address - Fax:800-890-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty