Provider Demographics
NPI:1891847950
Name:AUDREY REID AND ASSOCIATES,A MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:AUDREY REID AND ASSOCIATES,A MEDICAL GROUP,INC
Other - Org Name:HUNTINGTON PLAZA PEDIATRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-243-9000
Mailing Address - Street 1:800 FAIRMOUNT AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3150
Mailing Address - Country:US
Mailing Address - Phone:626-243-9000
Mailing Address - Fax:626-795-1269
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:STE 110
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-243-9000
Practice Address - Fax:626-795-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32644208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty