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General NPI Number Information
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NPI Number | 1104930536
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Entity Type | Individual
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Provider Name | BRIAN L REITZ P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 411 WEST LAKEVIEW AVE
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City | ANAHEIM
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State | CA
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Zip | 92807
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Country | US
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Telephone | 714-279-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 6065 NANTUCKET LN
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City | YORBA LINDA
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State | CA
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Zip | 92887-4714
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Country | US
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Telephone | 714-206-8285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | Q03353
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License Number State | CA
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