Provider Demographics
NPI:1073573903
Name:REDDY, JAYAPAL ARAGONDA
Entity Type:Individual
Prefix:
First Name:JAYAPAL
Middle Name:ARAGONDA
Last Name:REDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:CHAPARRAL MEDICAL GROUP
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:1866 N ORANGE GROVE AVE
Practice Address - Street 2:202
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3031
Practice Address - Country:US
Practice Address - Phone:909-623-8796
Practice Address - Fax:909-623-3076
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81459207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A814590Medicaid
CAG07219Medicare ID - Type Unspecified
CAWA81459AMedicare PIN
CA00A814590Medicaid