Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT7469 | CA |
NPI | 1003937970 |
---|---|
Provider Name | Diane Reid |
First Address | Anaheim, CA 92807-2075 |
Second Address | Anaheim, CA 92807-2075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT7469 | STATE LIC# (01) | CA |