Healthcare Provider Details

I. General information

NPI: 1366355885
Provider Name (Legal Business Name): CODY EUGENE REDDICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 COTTONWOOD AVE
SANTEE CA
92071-3092
US

IV. Provider business mailing address

14361 OLDE HIGHWAY 80
EL CAJON CA
92021-2841
US

V. Phone/Fax

Practice location:
  • Phone: 619-258-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP35185
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: