1003830415 NPI number — DR. KATHLEEN O'MALLEY REYNTJENS PHD

Table of content: DR. KATHLEEN O'MALLEY REYNTJENS PHD (NPI 1003830415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003830415 NPI number — DR. KATHLEEN O'MALLEY REYNTJENS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNTJENS
Provider First Name:
KATHLEEN
Provider Middle Name:
O'MALLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'MALLEY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003830415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32747
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87594-2747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-603-5052
Provider Business Mailing Address Fax Number:
505-982-9767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 DELGADO ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87501-2781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-820-0963
Provider Business Practice Location Address Fax Number:
505-982-9767
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  0974 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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