Healthcare Provider Details

I. General information

NPI: 1548680143
Provider Name (Legal Business Name): STEWART BORDEN REED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE STE 322
BURBANK CA
91505-4822
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-9020
  • Fax: 818-843-9021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA143198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: