Healthcare Provider Details

I. General information

NPI: 1437246220
Provider Name (Legal Business Name): SURYA M REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FLORIDA AVE
HEMET CA
92543-4513
US

IV. Provider business mailing address

1207 E FLORIDA AVE
HEMET CA
92543-4513
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-2523
  • Fax:
Mailing address:
  • Phone: 951-925-2523
  • Fax: 951-925-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA047916
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA47916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: