Healthcare Provider Details

I. General information

NPI: 1366856841
Provider Name (Legal Business Name): DANA COPELAND REDDY RHEUMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 CHURCH AVE STE 1
CHULA VISTA CA
91910-2718
US

IV. Provider business mailing address

272 CHURCH AVE STE 1
CHULA VISTA CA
91910-2718
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-1721
  • Fax: 619-427-1235
Mailing address:
  • Phone: 619-427-1721
  • Fax: 619-427-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA115598
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA115598
License Number StateCA

VIII. Authorized Official

Name: DR. DANA A REDDY
Title or Position: PRESIDENT
Credential: MD
Phone: 858-603-2068