Provider Demographics
NPI:1922166297
Name:REID, AUDREY YVONNE (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:YVONNE
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:REID-KRUGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
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:626-795-7051
Mailing Address - Fax:
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-795-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32644208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics