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NPI Code Detail

MEDICARE: RUSSELL LEE REED JR.

MEDICARE: RUSSELL LEE REED JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1811453723
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL LEE REED JR.
Provider Business Mailing Address
First Line : 9229 UTICA AVE STE 100
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-5435
Country : US
Telephone Number : 800-207-0272
Fax Number :
Provider Business Practice Location Address
First Line : 9229 UTICA AVE STE 100
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-5435
Country : US
Telephone Number : 800-207-0272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2019
Last Update Date : 11/12/2024

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Directions to “ RUSSELL LEE REED JR. ” Practice Location

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