Organization
SOUTH COUNTIES PEDIATRIC CRITICAL CARE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ZACHARIA REDA MD (PRESIDENT)
(714) 966-7253
Entity
Organization
Contact information
Practice address
17100 EUCLID ST, ATTN: PICU, FOUNTAIN VALLEY, CA 92708-4004
(714) 966-7253
Mailing address
17100 EUCLID ST, ATTN: PICU, FOUNTAIN VALLEY, CA 92708-4004
(714) 966-7253
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
—
—
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ57330Z
—
CA
Enumeration date
12/29/2005
Last updated
05/28/2015
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