Provider Demographics
NPI:1225456742
Name:JAG REDDY MD INC
Entity Type:Organization
Organization Name:JAG REDDY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAGADEESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:949-521-6060
Mailing Address - Street 1:6789 QUAIL HILL PKWY
Mailing Address - Street 2:#101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4233
Mailing Address - Country:US
Mailing Address - Phone:949-521-6060
Mailing Address - Fax:949-521-6063
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:SUITE 620
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3651
Practice Address - Country:US
Practice Address - Phone:949-521-6060
Practice Address - Fax:949-521-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty