Organization
SOUTH COUNTIES PEDIATRIC CRITICAL CARE MEDICAL GROUP
Active
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
Update your record
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