Provider Demographics
NPI:1114987500
Name:REDDY, RANGA C (MD)
Entity Type:Individual
Prefix:DR
First Name:RANGA
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 1:172 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2015
Mailing Address - Country:US
Mailing Address - Phone:626-966-1818
Mailing Address - Fax:626-332-8688
Practice Address - Street 1:172 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2015
Practice Address - Country:US
Practice Address - Phone:626-966-1818
Practice Address - Fax:626-332-8688
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31764Medicare ID - Type Unspecified