Provider Demographics
NPI:1407299852
Name:REED, TRACEY K
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:K
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 E BACH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2415
Mailing Address - Country:US
Mailing Address - Phone:310-987-5328
Mailing Address - Fax:424-264-5292
Practice Address - Street 1:1477 E BACH ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2415
Practice Address - Country:US
Practice Address - Phone:310-987-5328
Practice Address - Fax:424-264-5292
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily