Provider Demographics
NPI:1417970088
Name:REDA, THOMAS JOHN II (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:REDA
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:REDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6620 COYLE AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6337
Mailing Address - Country:US
Mailing Address - Phone:916-572-4720
Mailing Address - Fax:916-260-2275
Practice Address - Street 1:6620 COYLE AVE STE 214
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6337
Practice Address - Country:US
Practice Address - Phone:916-572-4720
Practice Address - Fax:916-260-2275
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC137887207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001414375Medicaid
H86584Medicare UPIN