Healthcare Provider Details

I. General information

NPI: 1932620986
Provider Name (Legal Business Name): DEEPTHI CIDDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W 6TH ST
RENO NV
89503-4548
US

IV. Provider business mailing address

PO BOX 1600
CARSON CITY NV
89702-1600
US

V. Phone/Fax

Practice location:
  • Phone: 775-770-6490
  • Fax: 775-770-3944
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20298
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20298
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: