1548276785 NPI number — DEBORAH JORDAN-REED N.P.

Table of content: DEBORAH JORDAN-REED N.P. (NPI 1548276785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548276785 NPI number — DEBORAH JORDAN-REED N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN-REED
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548276785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1682
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLFLOWER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90707-1682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-229-9452
Provider Business Mailing Address Fax Number:
562-920-4642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10251 ARTESIA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLFLOWER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90706-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-867-8681
Provider Business Practice Location Address Fax Number:
562-925-2721
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  NP2881 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0NP28810 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 500021848 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: RN296599 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".