Healthcare Provider Details

I. General information

NPI: 1891771713
Provider Name (Legal Business Name): MARK REED D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275N ROSE DR 136
PLACENTIA CA
92870-3919
US

IV. Provider business mailing address

1275N ROSE DR 136
PLACENTIA CA
92870-3919
US

V. Phone/Fax

Practice location:
  • Phone: 714-528-3668
  • Fax: 714-528-0739
Mailing address:
  • Phone: 714-528-3668
  • Fax: 714-528-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: