Healthcare Provider Details

I. General information

NPI: 1124014923
Provider Name (Legal Business Name): ANANTHRAM POTTIPATI REDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 ALVARADO RD STE 2301
SAN DIEGO CA
92120-5241
US

IV. Provider business mailing address

9456 CUYAMACA ST SUITE 102
SANTEE CA
92071-5915
US

V. Phone/Fax

Practice location:
  • Phone: 619-588-4074
  • Fax: 619-588-4004
Mailing address:
  • Phone: 619-588-4074
  • Fax: 619-588-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35064253
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number17118
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD044783L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC 52423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: