Provider Demographics
NPI:1558798918
Name:REED, JESSE LEE (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:LEE
Last Name:REED
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 ROCK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1030
Mailing Address - Country:US
Mailing Address - Phone:386-983-2640
Mailing Address - Fax:
Practice Address - Street 1:6016 ROCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-1030
Practice Address - Country:US
Practice Address - Phone:386-983-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman