Healthcare Provider Details

I. General information

NPI: 1407299852
Provider Name (Legal Business Name): TRACEY K REED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 E BACH ST
CARSON CA
90745-2415
US

IV. Provider business mailing address

1477 E BACH ST
CARSON CA
90745-2415
US

V. Phone/Fax

Practice location:
  • Phone: 310-987-5328
  • Fax: 424-264-5292
Mailing address:
  • Phone: 310-987-5328
  • Fax: 424-264-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: