Provider Demographics
NPI:1164490967
Name:REDDY, HANUMANDLA R (MD)
Entity Type:Individual
Prefix:DR
First Name:HANUMANDLA
Middle Name:R
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 1:1114 W 6TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4901
Mailing Address - Country:US
Mailing Address - Phone:559-582-0397
Mailing Address - Fax:559-582-9755
Practice Address - Street 1:1114 W 6TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4901
Practice Address - Country:US
Practice Address - Phone:559-582-0397
Practice Address - Fax:559-582-9755
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA00043484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A434840Medicaid
CA00A434840Medicaid
CAE57834Medicare UPIN