=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114222155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMANA & ANANTHRAM REDDY MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2011
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6699 ALVARADO RD SUITE 2301
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92120-5238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-588-4074
-----------------------------------------------------
Fax | 619-588-4004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6699 ALVARADO RD SUITE 2301
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92120-5238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-588-4074
-----------------------------------------------------
Fax | 619-588-4004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | BECKY NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-875-2865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | C52581
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | C52423
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------