Healthcare Provider Details

I. General information

NPI: 1700435211
Provider Name (Legal Business Name): PRIYA REDDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

3941 SHIRLENE PL
LA MESA CA
91941-7431
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-4213
  • Fax:
Mailing address:
  • Phone: 512-703-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95020387
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95198942
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95020387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: