Healthcare Provider Details

I. General information

NPI: 1699655639
Provider Name (Legal Business Name): MIKHAILA ASHLEY REID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PACKET LANDING RD
ALAMEDA CA
94502-6534
US

IV. Provider business mailing address

3921 HARRISON ST
OAKLAND CA
94611-4574
US

V. Phone/Fax

Practice location:
  • Phone: 510-629-6300
  • Fax:
Mailing address:
  • Phone: 805-558-7543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: