Provider Demographics
NPI:1184018012
Name:REED, LATESHA TIFFANY (NP)
Entity Type:Individual
Prefix:MRS
First Name:LATESHA
Middle Name:TIFFANY
Last Name:REED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LATESHA
Other - Middle Name:TIFFANY
Other - Last Name:JONES-REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, PMHNP
Mailing Address - Street 1:120 BIRMINGHAM DR STE 240A
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1757
Mailing Address - Country:US
Mailing Address - Phone:858-208-0121
Mailing Address - Fax:
Practice Address - Street 1:120 BIRMINGHAM DR STE 240A
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1757
Practice Address - Country:US
Practice Address - Phone:858-208-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002463363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily