Provider Demographics
NPI:1871720987
Name:REZNIK, ALENA (MD)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:REZNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8568 BURTON WAY
Mailing Address - Street 2:APT 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3345
Mailing Address - Country:US
Mailing Address - Phone:310-980-6038
Mailing Address - Fax:
Practice Address - Street 1:1401 AVOCADO AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7787
Practice Address - Country:US
Practice Address - Phone:949-288-2382
Practice Address - Fax:949-288-0344
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA113775207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1137750Medicaid
CAHE104ZMedicare PIN