Healthcare Provider Details

I. General information

NPI: 1124946694
Provider Name (Legal Business Name): CARMALISA KRISTELLE REICHHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N TUSTIN AVE STE 100
TUSTIN CA
92780-2937
US

IV. Provider business mailing address

131 N TUSTIN AVE STE 100
TUSTIN CA
92780-2937
US

V. Phone/Fax

Practice location:
  • Phone: 714-253-4154
  • Fax:
Mailing address:
  • Phone: 414-378-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-OJCITF
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: