Individual
IAN ALLAN REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BOCP
Contact information
Practice address
463 BREWSTER AVE, #6, REDWOOD CITY, CA 94063-1785
(650) 368-9597
Mailing address
796 7TH AVE, REDWOOD CITY, CA 94063-3921
(510) 335-5068
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C51219
BOC CERTIFICATION NUMBER
MT
Enumeration date
08/05/2013
Last updated
08/11/2015
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