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General NPI Number Information
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NPI Number | 1346509031
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Entity Type | Organization
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Legal Business Name | REDDIWANDLA SEENU REDDY, M.D., INC.
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 8881 FLETCHER PKWY STE #240
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City | LA MESA
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State | CA
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Zip | 91942-3134
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Country | US
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Telephone | 619-461-6130
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Fax | 619-461-3108
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Provider Business Mailing Address
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Address Line | 8881 FLETCHER PKWY STE #240
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City | LA MESA
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State | CA
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Zip | 91942-3134
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Country | US
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Telephone | 619-461-6130
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Fax | 619-461-3108
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Authorized Official
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Title or Position | OWNER
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Name | DR. REDDIWANDLA SEENU REDDY
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Credential | M.D.
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Telephone | 619-461-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A38098
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License Number State | CA
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