MEDICARE: LALLA-REDDY MEDICAL COPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	A75875	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376569277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LALLA-REDDY MEDICAL COPORATION

Provider Business Mailing Address
First Line	:	PO BOX 11629
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-5036
Country	:	US
Telephone Number	:	877-699-6743
Fax Number	:	949-298-9878

Provider Business Practice Location Address
First Line	:	9940 TALBERT AVE STE 101
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5153
Country	:	US
Telephone Number	:	877-699-6743
Fax Number	:	949-298-9878

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUJATA LALLA-REDDY
Credential	:	M.D
Telephone Number	:	949-478-1894

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/20/2026

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