Provider Demographics
NPI:1578762779
Name:DWARAKNATH P. REDDY, M.D.
Entity Type:Organization
Organization Name:DWARAKNATH P. REDDY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-629-5540
Mailing Address - Street 1:811 E 11TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4871
Mailing Address - Country:US
Mailing Address - Phone:909-629-5540
Mailing Address - Fax:909-946-3070
Practice Address - Street 1:811 E 11TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4871
Practice Address - Country:US
Practice Address - Phone:909-629-5540
Practice Address - Fax:909-946-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty