Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | A47947 | CA |
Y | 2080P0214X | Pediatric Pulmonologist | A47947 | CA |
NPI | 1487658936 |
---|---|
Provider Name | Zacharia Reda |
First Address | Fountain Valley, CA 92708 |
Second Address | Fountain Valley, CA 92708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 02/02/2012 |