Healthcare Provider Details

I. General information

NPI: 1780641712
Provider Name (Legal Business Name): SCOTT D REITER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 LINCOLN BLVD
SANTA MONICA CA
90405-5735
US

IV. Provider business mailing address

3010 LINCOLN BLVD
SANTA MONICA CA
90405-5735
US

V. Phone/Fax

Practice location:
  • Phone: 310-399-9142
  • Fax: 310-392-4212
Mailing address:
  • Phone: 310-399-9142
  • Fax: 310-392-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG42150
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberG42150
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG42150
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG42150
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG42150
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG42150
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG42150
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG42150
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberG42150
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberG42150
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG42150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: