Healthcare Provider Details

I. General information

NPI: 1124276266
Provider Name (Legal Business Name): NILZA MELLO REICH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 NORWOOD AVE
SACRAMENTO CA
95838-3300
US

IV. Provider business mailing address

625 FAIR OAKS AVE., #270
SOUTH PASADENA CA
91030-5801
US

V. Phone/Fax

Practice location:
  • Phone: 916-564-0521
  • Fax: 877-860-2907
Mailing address:
  • Phone: 626-346-2455
  • Fax: 626-639-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: