Healthcare Provider Details

I. General information

NPI: 1114189818
Provider Name (Legal Business Name): CENTRAL CALIFORNIA INTENSIVIST SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

PO BOX 79642
CITY OF INDUSTRY CA
91716-9642
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-5000
  • Fax:
Mailing address:
  • Phone: 330-470-3700
  • Fax: 330-497-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELWOOD PAUL REID
Title or Position: PRESIDENT
Credential: MD
Phone: 866-885-5522