Provider Demographics
NPI:1376080069
Name:TIV, REARSEIY SAM
Entity Type:Individual
Prefix:DR
First Name:REARSEIY
Middle Name:SAM
Last Name:TIV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NEWPORT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5943
Mailing Address - Country:US
Mailing Address - Phone:562-310-6820
Mailing Address - Fax:
Practice Address - Street 1:241 NEWPORT AVE APT 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5943
Practice Address - Country:US
Practice Address - Phone:562-310-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program