1891086948 NPI number — ANJANI T REDDY M.D.

Table of content: ANJANI T REDDY M.D. (NPI 1891086948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891086948 NPI number — ANJANI T REDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
ANJANI
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891086948
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5767 W CENTURY BLVD
Provider Second Line Business Mailing Address:
400
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-319-4700
Provider Business Mailing Address Fax Number:
310-453-5676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 COLORADO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-319-4700
Provider Business Practice Location Address Fax Number:
310-453-5376
Provider Enumeration Date:
04/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A115706 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891086948 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1891086948 . This is a "CALIFORNIA CHILDRENS SERVICES (CCS) PANELED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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