Provider Demographics
NPI:1467625277
Name:TUMMURU, GIRI REDDY (MD)
Entity Type:Individual
Prefix:
First Name:GIRI
Middle Name:REDDY
Last Name:TUMMURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 CORTONA CT
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-8630
Mailing Address - Country:US
Mailing Address - Phone:770-330-5007
Mailing Address - Fax:
Practice Address - Street 1:4077 CORTONA CT
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-8630
Practice Address - Country:US
Practice Address - Phone:770-330-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-12
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002543207R00000X
CAA112908208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGX292YMedicare PIN