Provider Demographics
NPI:1053948877
Name:JREIGE, NINA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:JREIGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-4103
Mailing Address - Country:US
Mailing Address - Phone:310-825-4073
Mailing Address - Fax:310-983-1172
Practice Address - Street 1:221 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1249
Practice Address - Country:US
Practice Address - Phone:310-825-4073
Practice Address - Fax:310-983-1172
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA185762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine