Provider Demographics
NPI:1205811106
Name:REILE, DALE ARTHUR (CRNA)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:ARTHUR
Last Name:REILE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0800
Mailing Address - Country:US
Mailing Address - Phone:909-889-7084
Mailing Address - Fax:909-889-7034
Practice Address - Street 1:400 N PEPPER AVE FL 2
Practice Address - Street 2:INLAND EMPIRE ANESTHESIA MEDICAL GROUP, INC.
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-2440
Practice Address - Fax:909-580-2441
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA692367500000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
430079040OtherRAILROAD MEDICARE
CARN2826430Medicaid
ZZZ24816ZMedicare ID - Type Unspecified