Provider Demographics
NPI:1679872774
Name:PHILLIPS, LAUREL REITZ (LM)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:REITZ
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LEMON GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2128
Mailing Address - Country:US
Mailing Address - Phone:805-689-5611
Mailing Address - Fax:
Practice Address - Street 1:411 LEMON GROVE LN
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2128
Practice Address - Country:US
Practice Address - Phone:805-689-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM296176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife