Healthcare Provider Details

I. General information

NPI: 1801250410
Provider Name (Legal Business Name): NEIL P REDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 615E
LOS ANGELES CA
90048-5910
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-8132
  • Fax: 310-659-3815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA140287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: