Provider Demographics
NPI:1164902375
Name:REITZ, EDMUND J (MDIV, DMIN)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:J
Last Name:REITZ
Suffix:
Gender:M
Credentials:MDIV, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 CARLOTTA DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-2676
Mailing Address - Country:US
Mailing Address - Phone:951-923-5458
Mailing Address - Fax:
Practice Address - Street 1:41431 GIBBEL RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-9570
Practice Address - Country:US
Practice Address - Phone:951-929-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral