Provider Demographics
NPI:1407849128
Name:REINHARDT, DAVID JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4227
Mailing Address - Country:US
Mailing Address - Phone:562-938-9598
Mailing Address - Fax:
Practice Address - Street 1:3008 OSTROM AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4227
Practice Address - Country:US
Practice Address - Phone:562-938-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14812103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY148120Medicaid
CACP14812Medicare ID - Type UnspecifiedMEDICARE ID