Provider Demographics
NPI:1457822157
Name:REDDY, BOMMIREDDY VISHWAS (ND)
Entity Type:Individual
Prefix:DR
First Name:BOMMIREDDY
Middle Name:VISHWAS
Last Name:REDDY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:BOMMI
Other - Middle Name:VISHWAS
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:35190 MARKS RD
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2039
Mailing Address - Country:US
Mailing Address - Phone:760-559-9278
Mailing Address - Fax:
Practice Address - Street 1:35190 MARKS RD
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2039
Practice Address - Country:US
Practice Address - Phone:760-559-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty