Provider Demographics
NPI:1184734113
Name:REISS, SHELDON (MD)
Entity type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:
Last Name:REISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 NORTH ROXBURY DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-274-1070
Mailing Address - Fax:310-278-5765
Practice Address - Street 1:435 NORTH ROXBURY DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-274-1070
Practice Address - Fax:310-278-5765
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30210207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G302100Medicaid
CA00G302100Medicaid
CAA44333Medicare UPIN
CAG30210Medicare PIN