Healthcare Provider Details

I. General information

NPI: 1629396353
Provider Name (Legal Business Name): JRP MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 10/18/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 MAGNOLIA AVE STE 203
RIVERSIDE CA
92503-3684
US

IV. Provider business mailing address

9670 MAGNOLIA AVE STE 201
RIVERSIDE CA
92503-3684
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-7400
  • Fax:
Mailing address:
  • Phone: 951-352-7400
  • Fax: 951-352-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JYOTHI AHALYA REDDY
Title or Position: PRESIDENT
Credential: MD
Phone: 951-354-3976