MEDICARE: MS. KEITA CYBELE REID PPS

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
1	103TS0200X	School Psychologist		CA

General Provider Information

NPI Number	:	1932959186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEITA CYBELE REID PPS

Provider Business Mailing Address
First Line	:	PO BOX 4526
Second Line	:
City	:	CARMEL
State	:	CA
Zip	:	93921-4526
Country	:	US
Telephone Number	:	831-250-3572
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 IMOLA AVE
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94559-3625
Country	:	US
Telephone Number	:	707-253-6810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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