Active NPI
Diana Pavlovna Reznikov, PHARM.D.
- Pharmacist
- Santa Rosa, CA
National Provider Identifier
1275902256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 73119
- Practice address
- 1165 Montgomery Dr
Santa Rosa, CA 95405-4801 - Phone
- (707) 525-5380
- NPI assigned
- Sep 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 73119 | CA | Primary |
Addresses
Primary practice location
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Mailing address
2105 Longhorn Cir
Santa Rosa, CA 95401-6750
Phone (707) 477-6996
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73119 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442534400000",
"number": "1275902256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2105 LONGHORN CIR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954016750",
"telephone_number": "707-477-6996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1165 MONTGOMERY DR",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954054801",
"telephone_number": "707-525-5380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REZNIKOV",
"first_name": "DIANA",
"middle_name": "PAVLOVNA",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-18",
"last_updated": "2015-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "73119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.