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General NPI Number Information
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NPI Number | 1124220181
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Entity Type | Organization
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Legal Business Name | SAN DIEGO INSTITUTE OF GASTROENTEROLOGY AND NUTRITION
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 6699 ALVARADO RD SUITE 2301
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City | SAN DIEGO
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State | CA
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Zip | 92120-5244
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Country | US
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Telephone | 619-229-1005
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Fax | 619-326-0380
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Provider Business Mailing Address
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Address Line | 6699 ALVARADO RD SUITE 2301
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City | SAN DIEGO
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State | CA
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Zip | 92120-5244
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Country | US
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Telephone | 619-229-1005
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Fax | 619-326-0380
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. ANANTHRAM POTTIPATI REDDY
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Credential | MD
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Telephone | 619-229-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2955846
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License Number State | CA
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