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General NPI Number Information
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NPI Number | 1417247412
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Entity Type | Individual
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Provider Name | RACQUEL ELISA REID M.D
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 1500 ROSECRANS AVE STE 500
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-3771
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Country | US
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Telephone | 323-380-1090
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Fax | 251-220-8666
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Provider Business Mailing Address
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Address Line | 4712 ADMIRALTY WAY # 409
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6905
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Country | US
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Telephone | 470-209-3680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R0487
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 70576
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 70576
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | R0487
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A151636
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A151636
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License Number State | CA
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