Provider Demographics
NPI:1245280940
Name:REITLER, FRED LELAND (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:LELAND
Last Name:REITLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23326 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3725
Mailing Address - Country:US
Mailing Address - Phone:310-257-7298
Mailing Address - Fax:310-598-3117
Practice Address - Street 1:3701 SKYPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4753
Practice Address - Country:US
Practice Address - Phone:310-378-2234
Practice Address - Fax:310-378-9795
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG35194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G351940OtherBLUE SHIELD
CAWG35194DMedicare ID - Type Unspecified
CAHH158ZMedicare PIN
CAA46252Medicare UPIN