Provider Demographics
NPI:1639822695
Name:REED, DAJANEL MARKISHE
Entity Type:Individual
Prefix:
First Name:DAJANEL
Middle Name:MARKISHE
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 1:344 PAMELA RD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5039
Mailing Address - Country:US
Mailing Address - Phone:626-502-9648
Mailing Address - Fax:
Practice Address - Street 1:931 BUENA VISTA ST STE 503
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1727
Practice Address - Country:US
Practice Address - Phone:626-408-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8005268196Medicaid