=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720112634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANITHA REDDI M.D,
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 12/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 HOSPITAL PKWY SANTA TERESA COMMUNITY HOSPITAL, DEPT. OF PEDIATRICS
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95119-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-972-6918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4157 PARMA CT
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-2254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-931-9133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A92404
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------