Healthcare Provider Details

I. General information

NPI: 1407874480
Provider Name (Legal Business Name): MELANIE S REITER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE S O'BRIEN PA

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 E BELL RD
PHOENIX AZ
85032-2112
US

IV. Provider business mailing address

PO BOX 80072
CITY OF INDUSTRY CA
91716-8072
US

V. Phone/Fax

Practice location:
  • Phone: 602-923-5000
  • Fax: 818-587-2493
Mailing address:
  • Phone: 818-340-9988
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: