Provider Demographics
NPI:1245215391
Name:REDDY, JOSEPH BATTULA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BATTULA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5238
Mailing Address - Country:US
Mailing Address - Phone:619-229-1005
Mailing Address - Fax:619-588-4004
Practice Address - Street 1:9456 CUYAMACA ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5919
Practice Address - Country:US
Practice Address - Phone:619-588-4074
Practice Address - Fax:619-588-4004
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46472207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A464720Medicaid
CAGG126AOtherAEC MEDICARE PTAN
CAD84129Medicare UPIN
CA00A464720Medicaid