Healthcare Provider Details

I. General information

NPI: 1760190110
Provider Name (Legal Business Name): SOUNISRA REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date: 04/23/2025
Reactivation Date: 05/13/2025

III. Provider practice location address

8216 CASSIDY CIR
RIVERSIDE CA
92509-7123
US

IV. Provider business mailing address

8216 CASSIDY CIR
RIVERSIDE CA
92509-7123
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-4995
  • Fax:
Mailing address:
  • Phone: 619-522-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: