Healthcare Provider Details

I. General information

NPI: 1982627956
Provider Name (Legal Business Name): TARA REID D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 N LAKEWOOD BLVD
LONG BEACH CA
90815-2507
US

IV. Provider business mailing address

2255 N LAKEWOOD BLVD
LONG BEACH CA
90815-2507
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-8000
  • Fax: 562-494-8880
Mailing address:
  • Phone: 562-498-8000
  • Fax: 562-494-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A6919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: