Provider Demographics
NPI:1962613703
Name:REAT, VITOU
Entity type:Individual
Prefix:
First Name:VITOU
Middle Name:
Last Name:REAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1254
Mailing Address - Country:US
Mailing Address - Phone:619-283-9624
Mailing Address - Fax:619-641-7656
Practice Address - Street 1:4275 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1254
Practice Address - Country:US
Practice Address - Phone:619-283-9624
Practice Address - Fax:619-641-7656
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator