Provider Demographics
NPI:1134728603
Name:REH, PHILIP (LAC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:REH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:PHIL
Other - Middle Name:
Other - Last Name:REH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:451 INDIAN SPRINGS RD.
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4238
Mailing Address - Country:US
Mailing Address - Phone:323-926-9566
Mailing Address - Fax:
Practice Address - Street 1:451 INDIAN SPRINGS RD.
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4238
Practice Address - Country:US
Practice Address - Phone:323-926-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist