1508164211 NPI number — SUDHIR K REDDY MD INC

Table of content: (NPI 1508164211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508164211 NPI number — SUDHIR K REDDY MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUDHIR K REDDY MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1508164211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 E 11TH ST STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-982-2279
Provider Business Mailing Address Fax Number:
909-946-3070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 E 11TH ST STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-982-2279
Provider Business Practice Location Address Fax Number:
909-946-3070
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
SUDHIR
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
909-946-4566

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A48880 , 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: C44811 . This is a "UPIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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