Provider Demographics
NPI:1598242059
Name:KITADE, REYLENE
Entity Type:Individual
Prefix:
First Name:REYLENE
Middle Name:
Last Name:KITADE
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 1:6846 CHEVY CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1905
Mailing Address - Country:US
Mailing Address - Phone:916-812-7355
Mailing Address - Fax:
Practice Address - Street 1:6846 CHEVY CHASE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1905
Practice Address - Country:US
Practice Address - Phone:916-812-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist