Provider Demographics
NPI:1215943758
Name:REITH, JAMES L (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:REITH
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:2409 ARTESIA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3207
Mailing Address - Country:US
Mailing Address - Phone:424-276-4700
Mailing Address - Fax:424-903-1099
Practice Address - Street 1:631 W AVENUE Q STE B
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3892
Practice Address - Country:US
Practice Address - Phone:661-947-9000
Practice Address - Fax:661-266-8751
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13597207N00000X
CAPA13597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13597OtherPA LICENSE