MEDICARE: VIJAYA M REDDY MD INC

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	207L00000X	Anesthesiology Physician	A69268	CA

General Provider Information

NPI Number	:	1407246556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIJAYA M REDDY MD INC

Provider Business Mailing Address
First Line	:	700 IRWIN ST. #102
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901
Country	:	US
Telephone Number	:	415-289-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	39350 CIVIC CENTER DR.
Second Line	:	#100
City	:	FREMONT
State	:	CA
Zip	:	94538-0000
Country	:	US
Telephone Number	:	510-456-4600
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN, OWNER
Name	:	DR. VIJAYALAKASHMI M REDDY
Credential	:	MD
Telephone Number	:	415-499-5132

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	07/22/2015

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