Provider Demographics
NPI:1538889530
Name:MIDDLETON, REGINALD B
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:B
Last Name:MIDDLETON
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 1:825 BARTOLO AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3705
Mailing Address - Country:US
Mailing Address - Phone:704-904-0302
Mailing Address - Fax:
Practice Address - Street 1:825 BARTOLO AVE
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3705
Practice Address - Country:US
Practice Address - Phone:704-904-0302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle