Healthcare Provider Details

I. General information

NPI: 1831947761
Provider Name (Legal Business Name): LAURA REIGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 SHAW DR
SAN JOSE CA
95118-1363
US

IV. Provider business mailing address

4750 ALMADEN EXPRESSWAY, PMB 385 UNIT 124
SAN JOSE CA
95118
US

V. Phone/Fax

Practice location:
  • Phone: 408-439-7015
  • Fax:
Mailing address:
  • Phone: 408-439-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: