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General NPI Number Information
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NPI Number | 1487893723
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Entity Type | Organization
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Legal Business Name | MARC WIMES-REITZ PH.D.
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 23945 CALABASAS RD SUITE 202
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City | CALABASAS
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State | CA
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Zip | 91302-1552
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Country | US
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Telephone | 818-591-8270
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Fax | 818-591-8271
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Provider Business Mailing Address
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Address Line | 23945 CALABASAS RD SUITE 202
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City | CALABASAS
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State | CA
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Zip | 91302-1552
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Country | US
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Telephone | 818-591-8270
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Fax | 818-591-8271
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARC EDMOND WILMES-REITZ
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Credential | PH.D.
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Telephone | 818-591-8270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PSY9368
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License Number State | CA
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