Healthcare Provider Details

I. General information

NPI: 1679963524
Provider Name (Legal Business Name): REDDY BIOMEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 CARDINAL CT STE 390
SAN DIEGO CA
92123-3357
US

IV. Provider business mailing address

4203 GENESEE AVE STE 103
SAN DIEGO CA
92117-4950
US

V. Phone/Fax

Practice location:
  • Phone: 619-900-7302
  • Fax: 855-819-3916
Mailing address:
  • Phone: 619-900-7302
  • Fax: 855-819-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA120797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA120797
License Number StateCA

VIII. Authorized Official

Name: DR. SAMATHHA R REDDY
Title or Position: OWNER
Credential: M.D.
Phone: 619-900-7302