Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 20A6636 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 20A6636 | CA |
NPI | 1215050299 |
---|---|
Provider Name | Dr. David Leroy Redding |
First Address | Pomona, CA 91766-2007 |
Second Address | Pomona, CA 91766-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 15/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX66360 | (05) | CA |
G62083 | (02) | CA |