MEDICARE: REIKO TRUE PHD

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	103T00000X	Psychologist	PSY5412	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY5412	OTHER	CA	CLINICAL PSYCHOLOGY

General Provider Information

NPI Number	:	1801837760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REIKO TRUE PHD

Provider Business Mailing Address
First Line	:	5326 SILVA AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-1432
Country	:	US
Telephone Number	:	510-233-2082
Fax Number	:	510-233-2997

Provider Business Practice Location Address
First Line	:	1801 BUSH ST
Second Line	:	SUITE 131-B
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5239
Country	:	US
Telephone Number	:	415-346-3495
Fax Number	:	510-233-2997

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/10/2012

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Directions to “ REIKO TRUE PHD” Practice Location

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