Provider Demographics
NPI:1831947761
Name:REIGEL, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:REIGEL
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 1:4750 ALMADEN EXPRESSWAY, PMB 385
Mailing Address - Street 2:UNIT 124
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-439-7015
Mailing Address - Fax:
Practice Address - Street 1:1559 SHAW DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1363
Practice Address - Country:US
Practice Address - Phone:408-439-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education