Healthcare Provider Details

I. General information

NPI: 1891079885
Provider Name (Legal Business Name): MANORAMA M REDDY M.D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2011
Last Update Date: 10/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4533 COLLEGE AVE
SAN DIEGO CA
92115-4010
US

IV. Provider business mailing address

4533 COLLEGE AVE
SAN DIEGO CA
92115-4010
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-8700
  • Fax: 619-583-5866
Mailing address:
  • Phone: 619-583-8700
  • Fax: 619-583-5866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA39669
License Number StateCA

VIII. Authorized Official

Name: MANORAMA M REDDY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-583-8700