Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G70735 | CA |
NPI | 1225292279 |
---|---|
Provider Name | Ellen Nadine Reich |
First Address | Tustin, CA 92782-8737 |
Second Address | Fountain Valley, CA 92708-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 17/07/2008 |