Provider Demographics
NPI:1407246556
Name:VIJAYA M REDDY MD INC
Entity Type:Organization
Organization Name:VIJAYA M REDDY MD INC
Other - Org Name:VIJAYALAKSHMI M REDDY OWNER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYALAKASHMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-499-5132
Mailing Address - Street 1:700 IRWIN ST. #102
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-289-1160
Mailing Address - Fax:
Practice Address - Street 1:39350 CIVIC CENTER DR.
Practice Address - Street 2:#100
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-0000
Practice Address - Country:US
Practice Address - Phone:510-456-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty