MEDICARE: JANE MARIE REITZ MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT 27449	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFT 27449	OTHER	CA	MARRIAGE FAMILY THERAPIST

General Provider Information

NPI Number	:	1326246620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE MARIE REITZ MFT

Provider Business Mailing Address
First Line	:	543 21ST ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2201
Country	:	US
Telephone Number	:	310-545-4057
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 PACIFIC COAST HWY
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2757
Country	:	US
Telephone Number	:	310-545-4532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2007
Last Update Date	:	07/08/2007

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