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NPI Code Detail

MEDICARE: ROBERT A. REISS MD

MEDICARE: ROBERT A. REISS MD
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
1207R00000XInternal Medicine PhysicianG32383CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G32383OTHERCASTATE LIC #

General Provider Information

NPI Number : 1588746150
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT A. REISS MD
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number : 310-301-8707
Fax Number : 310-301-8751
Provider Business Practice Location Address
First Line : 501 DEEP VALLEY DR STE 100
Second Line :
City : ROLLING HILLS ESTATES
State : CA
Zip : 90274-7606
Country : US
Telephone Number : 310-670-1120
Fax Number : 310-670-1433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 01/12/2023

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