Provider Demographics
NPI:1124220181
Name:SAN DIEGO INSTITUTE OF GASTROENTEROLOGY AND NUTRITION
Entity Type:Organization
Organization Name:SAN DIEGO INSTITUTE OF GASTROENTEROLOGY AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANTHRAM
Authorized Official - Middle Name:POTTIPATI
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-229-1005
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:SUITE 2301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5244
Mailing Address - Country:US
Mailing Address - Phone:619-229-1005
Mailing Address - Fax:619-326-0380
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:SUITE 2301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5244
Practice Address - Country:US
Practice Address - Phone:619-229-1005
Practice Address - Fax:619-326-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2955846207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52423OtherMEDICAL LICENSE- ANANTHRAM REDDY, MD
CAA46472OtherMEDICAL LICENSE- JOSEPH B. REDDY
CA00A464720Medicaid
CA00C524230Medicaid
CAA46472OtherMEDICAL LICENSE - JOSEPH REDDY, MD
CAC52423OtherMEDICAL LICENSE -ANANTHRAM P. REDDY