Healthcare Provider Details

I. General information

NPI: 1396935979
Provider Name (Legal Business Name): REID MAXWELL WAINESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N SANTA ANITA AVE STE 403
ARCADIA CA
91006-3183
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 626-269-5371
  • Fax: 626-574-0488
Mailing address:
  • Phone: 626-568-8838
  • Fax: 626-796-7657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA108766
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA108766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: