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General NPI Number Information
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NPI Number | 1700063724
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Entity Type | Individual
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Provider Name | KAMAKSHI RADHA REDDY M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD BLDG 206 WLA VETERANS HOSPITAL
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-478-3711
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Fax | 310-268-4914
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Provider Business Mailing Address
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Address Line | 11301 WILSHIRE BLVD BLDG 206 WLA VETERANS HOSPITAL
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-478-3711
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Fax | 310-268-4914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37459
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License Number State | AZ
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