Provider Demographics
NPI:1598828022
Name:REDDY, VIJAYALAKSHMI M
Entity Type:Individual
Prefix:DR
First Name:VIJAYALAKSHMI
Middle Name:M
Last Name:REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 IRWIN ST
Mailing Address - Street 2:#102
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3339
Mailing Address - Country:US
Mailing Address - Phone:415-460-9927
Mailing Address - Fax:
Practice Address - Street 1:2675 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2323
Practice Address - Country:US
Practice Address - Phone:510-792-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology