Provider Demographics
NPI:1366856841
Name:DANA COPELAND REDDY RHEUMATOLOGY PC
Entity Type:Organization
Organization Name:DANA COPELAND REDDY RHEUMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-427-1721
Mailing Address - Street 1:272 CHURCH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2718
Mailing Address - Country:US
Mailing Address - Phone:619-427-1721
Mailing Address - Fax:619-427-1235
Practice Address - Street 1:272 CHURCH AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2718
Practice Address - Country:US
Practice Address - Phone:619-427-1721
Practice Address - Fax:619-427-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115598261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21969Medicare UPIN