Provider Demographics
NPI:1033221007
Name:REDDY, JYOTHI AHALYA (MD)
Entity Type:Individual
Prefix:
First Name:JYOTHI
Middle Name:AHALYA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9670 MAGNOLIA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3684
Mailing Address - Country:US
Mailing Address - Phone:951-354-3976
Mailing Address - Fax:951-354-2024
Practice Address - Street 1:9670 MAGNOLIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3684
Practice Address - Country:US
Practice Address - Phone:951-354-3976
Practice Address - Fax:951-354-2924
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034669207RG0100X
IL036093840207RG0100X
IN01045025A207RG0100X
CAA44374207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093840Medicaid
IL213500Medicare UPIN
IL036093840Medicaid