Healthcare Provider Details

I. General information

NPI: 1952334583
Provider Name (Legal Business Name): LOVRDU PRABHAKAR PYREDDY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6181 N THESTA AVE SUITE # 104
FRESNO CA
93710-8604
US

IV. Provider business mailing address

6181 N THESTA ST SUITE 104
FRESNO CA
93710-8604
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-9753
  • Fax: 559-431-3478
Mailing address:
  • Phone: 559-431-9753
  • Fax: 559-431-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA94932
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA94932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: