Provider Demographics
NPI:1992863419
Name:REID, CHRISTINA CHLOE (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CHLOE
Last Name:REID
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2217
Mailing Address - Country:US
Mailing Address - Phone:562-506-0456
Mailing Address - Fax:562-595-0062
Practice Address - Street 1:2704 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2217
Practice Address - Country:US
Practice Address - Phone:562-506-0456
Practice Address - Fax:562-595-0062
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant