=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952334583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOVRDU PRABHAKAR PYREDDY M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 08/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6181 N THESTA AVE SUITE # 104
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710-8604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-431-9753
-----------------------------------------------------
Fax | 559-431-3478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6181 N THESTA ST SUITE 104
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710-8604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-431-9753
-----------------------------------------------------
Fax | 559-431-3478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | A94932
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | A94932
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------