Healthcare Provider Details

I. General information

NPI: 1245280940
Provider Name (Legal Business Name): FRED LELAND REITLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SKYPARK DR SUITE 100
TORRANCE CA
90505-4753
US

IV. Provider business mailing address

23326 HAWTHORNE BLVD SUITE 200
TORRANCE CA
90505-3725
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-2234
  • Fax: 310-378-9795
Mailing address:
  • Phone: 310-257-7298
  • Fax: 310-598-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG35194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: