Healthcare Provider Details

I. General information

NPI: 1548203961
Provider Name (Legal Business Name): VINAY MOOLA REDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 DUCKHORN DR #200
SACRAMENTO CA
95834
US

IV. Provider business mailing address

8825 BELLA TERRA PL
GRANITE BAY CA
95746-8850
US

V. Phone/Fax

Practice location:
  • Phone: 916-419-9900
  • Fax: 916-419-9699
Mailing address:
  • Phone: 916-419-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number00A63460
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA63460
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA63460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: