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General NPI Number Information
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NPI Number | 1831324334
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Entity Type | Organization
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Legal Business Name | DIVAKAR KRISHNAREDDY MD INC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 120 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 661-435-9049
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Fax | 323-443-3601
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Provider Business Mailing Address
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Address Line | 120 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 661-435-9049
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Fax | 323-443-3601
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIVAKAR KRISHNAREDDY
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Credential | MD
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Telephone | 661-435-9049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A35665
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License Number State | CA
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