Provider Demographics
NPI:1932287158
Name:ELISE A. REED DO A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ELISE A. REED DO A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWE-MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-433-7944
Mailing Address - Street 1:2023 W VISTA WAY
Mailing Address - Street 2:SUITE K-2
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6030
Mailing Address - Country:US
Mailing Address - Phone:760-941-6062
Mailing Address - Fax:760-726-3509
Practice Address - Street 1:2023 W VISTA WAY
Practice Address - Street 2:SUITE K-2
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6030
Practice Address - Country:US
Practice Address - Phone:760-941-6062
Practice Address - Fax:760-726-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A64312084P0800X
OK20A64312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6431Medicare ID - Type Unspecified
G89288Medicare UPIN
CAG89288Medicare UPIN