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Individual
MR. SOL REISIN
Active
Individual
MR. SOL REISIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A39697
CA
207RN0300X
Nephrology Physician
Primary
A39697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A396970
—
CA
01
—
110111657
RAILROAD PIN#
CA
01
—
GR0066310
GROUP MEDI-CAL #
CA
01
—
W13536
MEDICARE GROUP #
CA
01
—
WA39697B
MEDICARE PTAN
CA
01
—
ZZZ47484Z
BLUE SHIELD ZZZ#
CA
Enumeration date
05/03/2006
Last updated
12/19/2016
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