Healthcare Provider Details

I. General information

NPI: 1720112634
Provider Name (Legal Business Name): ANITHA REDDI M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PKWY SANTA TERESA COMMUNITY HOSPITAL, DEPT. OF PEDIATRICS
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

4157 PARMA CT
PLEASANTON CA
94566-2254
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-6918
  • Fax:
Mailing address:
  • Phone: 925-931-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: