Healthcare Provider Details

I. General information

NPI: 1841347077
Provider Name (Legal Business Name): KEITH EDWARD REID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 W CITRACADO PKWY
ESCONDIDO CA
92029-4159
US

IV. Provider business mailing address

16955 VIA DEL CAMPO SUITE 215
SAN DIEGO CA
92127-7720
US

V. Phone/Fax

Practice location:
  • Phone: 422-281-5000
  • Fax:
Mailing address:
  • Phone: 858-673-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA134785
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: