Healthcare Provider Details

I. General information

NPI: 1407995038
Provider Name (Legal Business Name): REDDY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 N MAPLE AVE STE 108
FRESNO CA
93720-8008
US

IV. Provider business mailing address

7045 N MAPLE AVE STE 108
FRESNO CA
93720-8008
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-7393
  • Fax: 559-369-2488
Mailing address:
  • Phone: 559-326-7393
  • Fax: 559-369-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA55459
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA49497
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18274
License Number StateCA

VIII. Authorized Official

Name: KIRAN REDDY
Title or Position: OWNER
Credential: MD
Phone: 559-326-7393