Provider Demographics
NPI:1053467571
Name:REID, DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 N 70TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5928
Mailing Address - Country:US
Mailing Address - Phone:623-478-2870
Mailing Address - Fax:
Practice Address - Street 1:3540 E BASELINE RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-9630
Practice Address - Country:US
Practice Address - Phone:602-323-3000
Practice Address - Fax:602-243-5390
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34764282E00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ997950Medicaid