Healthcare Provider Details

I. General information

NPI: 1508836594
Provider Name (Legal Business Name): STEPHEN LEE REITMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 GARFIELD STREET SUITE A
LA MESA CA
91941-5103
US

IV. Provider business mailing address

5111 GARFIELD STREET SUITE A
LA MESA CA
91941-5103
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-4050
  • Fax: 619-460-7441
Mailing address:
  • Phone: 619-460-4050
  • Fax: 619-460-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG25924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: