Provider Demographics
NPI:1861231011
Name:REIMERS, SAMUEL ELIJAH
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ELIJAH
Last Name:REIMERS
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 1:1234 N REDDING WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3144
Mailing Address - Country:US
Mailing Address - Phone:909-660-9293
Mailing Address - Fax:
Practice Address - Street 1:1234 N REDDING WAY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3144
Practice Address - Country:US
Practice Address - Phone:909-660-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider