REGINALD JOHN SOUTHALL

LOS ANGELES, CA
NPI1669105854
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: CA  PA64702)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2022-07-05
Last Update Date2024-06-28
Business Address
REGINALD JOHN SOUTHALL
8700 BEVERLY BLVD
LOS ANGELES, CA 90048
Phone number: 310-423-8780
Mailing Address
REGINALD JOHN SOUTHALL
4140 W 190TH ST
TORRANCE, CA 90504-5513
Phone number: