Healthcare Provider Details

I. General information

NPI: 1184018012
Provider Name (Legal Business Name): LATESHA TIFFANY REED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATESHA TIFFANY JONES-REED FNP, PMHNP

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

IV. Provider business mailing address

120 BIRMINGHAM DR STE 240A
CARDIFF CA
92007-1757
US

V. Phone/Fax

Practice location:
  • Phone: 858-208-0121
  • Fax:
Mailing address:
  • Phone: 858-208-0121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002463
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95002463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: