Provider Demographics
NPI:1730240110
Name:JAIN, REENA (MB BS MD)
Entity type:Individual
Prefix:DR
First Name:REENA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MB BS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 994212
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099
Mailing Address - Country:US
Mailing Address - Phone:530-244-1525
Mailing Address - Fax:530-244-1552
Practice Address - Street 1:2105 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-244-1525
Practice Address - Fax:530-244-1552
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA314212080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314210Medicaid
A26471Medicare UPIN