Basic Information
| Provider Information | |||||||||
| NPI: | 1740216654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REID | ||||||||
| FirstName: | JANELL | ||||||||
| MiddleName: | D'ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12791 NEWPORT AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147316549 | ||||||||
| FaxNumber: | 7147305372 | ||||||||
| Practice Location | |||||||||
| Address1: | 12791 NEWPORT AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147316549 | ||||||||
| FaxNumber: | 7147305372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | AU566 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | AU0005661 | 05 | CA | MEDICAID |