Healthcare Provider Details

I. General information

NPI: 1679641104
Provider Name (Legal Business Name): ARCHANA P. REDDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

6196 TRACEL DR
SAN JOSE CA
95129-4761
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6820
  • Fax: 209-468-6103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC54793
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: