Provider Demographics
NPI:1962702019
Name:REAVIS, KAREN (NP)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:REAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 RUFFIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1860
Mailing Address - Country:US
Mailing Address - Phone:858-569-6800
Mailing Address - Fax:868-569-6807
Practice Address - Street 1:7625 MESA COLLEGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:888-598-2007
Practice Address - Fax:888-598-7002
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19872363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health