Provider Demographics
NPI:1194813980
Name:FLOYD, RETA D (MD)
Entity type:Individual
Prefix:DR
First Name:RETA
Middle Name:D
Last Name:FLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 INDUSTRY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4028
Mailing Address - Country:US
Mailing Address - Phone:310-631-8004
Mailing Address - Fax:310-631-5875
Practice Address - Street 1:924 BUENA VISTA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1779
Practice Address - Country:US
Practice Address - Phone:626-357-7177
Practice Address - Fax:626-357-5357
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C372260Medicaid