Provider Demographics
NPI:1548802259
Name:REITMAYER, LEAH (RD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:REITMAYER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3614
Mailing Address - Country:US
Mailing Address - Phone:760-519-9218
Mailing Address - Fax:
Practice Address - Street 1:1402 INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3614
Practice Address - Country:US
Practice Address - Phone:760-519-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86075274133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered