Provider Demographics
NPI:1457437238
Name:REEDUS, DESIREE (MD)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:REEDUS
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 1:29995 LOS NOGALES RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1821
Mailing Address - Country:US
Mailing Address - Phone:951-506-1013
Mailing Address - Fax:
Practice Address - Street 1:1200 ENCLAVE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1764
Practice Address - Country:US
Practice Address - Phone:281-870-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA84122OtherM.D. LICENSE
G92856Medicare UPIN