Basic Information
Provider Information
NPI: 1003805029
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: RICHARD
MiddleName: A.
NamePrefix: DR.
NameSuffix:  
Credential: MEDICAL DOCTOR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 223 N 1ST AVE
Address2: SUITE #201
City: ARCADIA
State: CA
PostalCode: 910067089
CountryCode: US
TelephoneNumber: 6266987246
FaxNumber:  
Practice Location
Address1: 100 W CALIFORNIA BLVD
Address2:  
City: PASADENA
State: CA
PostalCode: 911053010
CountryCode: US
TelephoneNumber: 6263975139
FaxNumber: 6264471058
Other Information
ProviderEnumerationDate: 10/21/2005
LastUpdateDate: 10/21/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XG56692CAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0204XG56692CAN Allopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
2085U0001XG56692CAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound

ID Information
IDTypeStateIssuerDescription
00G56692005CA MEDICAID


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