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General NPI Number Information
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NPI Number | 1407187172
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Entity Type | Organization
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Legal Business Name | REDA TADROS, MD, INC
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 555 S 7TH AVE
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City | BARSTOW
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State | CA
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Zip | 92311-3043
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-3911
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Provider Business Mailing Address
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Address Line | 1633 ERRINGER RD 1ST FLOOR
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City | SIMI VALLEY
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State | CA
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Zip | 93065-3583
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-3911
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. REDA TADROS
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Credential | MD
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Telephone | 760-245-8691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number | 05D0573118
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License Number State | CA
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