MEDICARE: JOHN REITANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD047753L	PA
2	2084P0800X	Psychiatry Physician	19465	NV

General Provider Information

NPI Number	:	1033285218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN REITANO M.D.

Provider Business Mailing Address
First Line	:	526 S TONOPAH DR STE 140-160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4043
Country	:	US
Telephone Number	:	702-897-7250
Fax Number	:	702-706-4838

Provider Business Practice Location Address
First Line	:	526 S TONOPAH DR STE 140-160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4043
Country	:	US
Telephone Number	:	702-897-7250
Fax Number	:	702-706-4838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/19/2024

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