Healthcare Provider Details

I. General information

NPI: 1700840345
Provider Name (Legal Business Name): NITHIN C REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5893 COPLEY DR DEPARTMENT OF ORTHOPEDICS
SAN DIEGO CA
92111-7906
US

IV. Provider business mailing address

5893 COPLEY DR DEPARTMENT OF ORTHOPEDICS
SAN DIEGO CA
92111-7906
US

V. Phone/Fax

Practice location:
  • Phone: 858-616-5212
  • Fax:
Mailing address:
  • Phone: 858-616-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA83846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: