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1053300251

NPI Code Detail

MEDICARE: DR. SUMANA REDDY MD

MEDICARE: DR. SUMANA REDDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	35-072256P	OH
2	207K00000X	Allergy & Immunology Physician	C52581	CA
3	207K00000X	Allergy & Immunology Physician	MD-045281-L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GN258A	OTHER	CA	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C52581	OTHER	CA	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053300251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUMANA REDDY MD

Provider Business Mailing Address
First Line	:	875 EL CAJON BLVD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-5714
Country	:	US
Telephone Number	:	619-662-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 EL CAJON BLVD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-5714
Country	:	US
Telephone Number	:	619-662-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	02/20/2025

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Directions to “ DR. SUMANA REDDY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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