Provider Demographics
NPI:1225643588
Name:REIS, KIANI
Entity Type:Individual
Prefix:
First Name:KIANI
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 ALONZO AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3611
Mailing Address - Country:US
Mailing Address - Phone:818-654-1314
Mailing Address - Fax:818-705-0209
Practice Address - Street 1:5031 ALONZO AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3611
Practice Address - Country:US
Practice Address - Phone:818-654-1314
Practice Address - Fax:818-705-0209
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2000259722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer