Healthcare Provider Details

I. General information

NPI: 1952490328
Provider Name (Legal Business Name): SURENDHER LOKAREDDY MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 W 24TH ST
YUMA AZ
85364-6105
US

IV. Provider business mailing address

1945 W 24TH ST
YUMA AZ
85364-6105
US

V. Phone/Fax

Practice location:
  • Phone: 928-341-4650
  • Fax: 928-341-9779
Mailing address:
  • Phone: 928-341-4650
  • Fax: 928-341-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7451
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7222
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP3863
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22345
License Number StateAZ

VIII. Authorized Official

Name: DR. SURENDHER LOKAREDDY
Title or Position: DOCTOR
Credential: M.D
Phone: 928-341-4650