=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730398090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREA J REICHE MD, A MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6815 NOBLE AVE
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-901-1010
-----------------------------------------------------
Fax | 818-901-0553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6815 NOBLE AVE
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-901-1010
-----------------------------------------------------
Fax | 818-901-0553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | ANDREA J REICHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-901-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | A50973
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------