Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 297868 | CA |
Y | 213ES0000X | Sports Medicine | 297868 | CA |
NPI | 1235731050 |
---|---|
Provider Name | Alexis Reid |
First Address | Palo Alto, CA 94306-3324 |
Second Address | Palo Alto, CA 94306-3324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
297868 | LICENSE (01) | CA |