Provider Demographics
NPI:1134300221
Name:REISS, DAVID MITCHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MITCHEL
Last Name:REISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9684
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-4684
Mailing Address - Country:US
Mailing Address - Phone:619-280-3422
Mailing Address - Fax:619-280-3406
Practice Address - Street 1:3505 CAMINO DEL RIO S
Practice Address - Street 2:SUITE #305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4002
Practice Address - Country:US
Practice Address - Phone:619-280-3422
Practice Address - Fax:619-280-3406
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG418012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADRG41801AMedicare UPIN