Provider Demographics
NPI:1508836594
Name:REITMAN, STEPHEN LEE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:REITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 GARFIELD STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5103
Mailing Address - Country:US
Mailing Address - Phone:619-460-4050
Mailing Address - Fax:619-460-7441
Practice Address - Street 1:5111 GARFIELD STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5103
Practice Address - Country:US
Practice Address - Phone:619-460-4050
Practice Address - Fax:619-460-7441
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G259240Medicaid
CA00G259240Medicaid
CAG25924Medicare ID - Type Unspecified