Provider Demographics
NPI:1083610703
Name:REDDY, JAGADEESH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGADEESH
Middle Name:C
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25467 NELLIE GAIL RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6306
Mailing Address - Country:US
Mailing Address - Phone:949-521-6060
Mailing Address - Fax:949-521-6063
Practice Address - Street 1:31852 COAST HWY
Practice Address - Street 2:STE 201
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6765
Practice Address - Country:US
Practice Address - Phone:949-715-0505
Practice Address - Fax:949-715-0508
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82683207R00000X, 207RG0300X, 207RI0200X
FLME88635207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269550200Medicaid
FL269550200Medicaid
FLU2665YMedicare PIN
CAWA82683AMedicare PIN