Healthcare Provider Details

I. General information

NPI: 1265428403
Provider Name (Legal Business Name): NARALA & MADIREDDY MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE STE 102
FRESNO CA
93720-2989
US

IV. Provider business mailing address

568 E HERNDON AVE STE 102
FRESNO CA
93720-2989
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-7500
  • Fax: 559-248-2472
Mailing address:
  • Phone: 559-221-7500
  • Fax: 559-248-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51491
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA51494
License Number StateCA

VIII. Authorized Official

Name: DR. MADHAVA REDDY NARALA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-221-7500