Provider Demographics
NPI:1083854558
Name:REED, ELISE A (DO A PROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:A
Last Name:REED
Suffix:
Gender:F
Credentials:DO A PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 WEST VISTA WAY
Mailing Address - Street 2:SUITE K-2
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6030
Mailing Address - Country:US
Mailing Address - Phone:760-941-6062
Mailing Address - Fax:760-726-3509
Practice Address - Street 1:2023 WEST VISTA WAY
Practice Address - Street 2:SUITE K-2
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:760-941-6062
Practice Address - Fax:760-726-3509
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20A64312084P0800X
CA20A64312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89288Medicare UPIN