Healthcare Provider Details

I. General information

NPI: 1326391186
Provider Name (Legal Business Name): VIMALA T REDDY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CREEK RD SUITE 140
IRVINE CA
92604-4791
US

IV. Provider business mailing address

33 CREEK RD SUITE 140
IRVINE CA
92604-4791
US

V. Phone/Fax

Practice location:
  • Phone: 949-679-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIMALA T REDDY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-540-3061