Healthcare Provider Details

I. General information

NPI: 1508384017
Provider Name (Legal Business Name): REINO LABS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PALISADES DR STE O
PACIFIC PALISADES CA
90272-2174
US

IV. Provider business mailing address

1324 AVENIDA DE CORTEZ
PACIFIC PALISADES CA
90272-2123
US

V. Phone/Fax

Practice location:
  • Phone: 310-529-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number26882
License Number StateCA

VIII. Authorized Official

Name: ALEXANDER REINLIEB
Title or Position: OWNER
Credential:
Phone: 973-715-6077