Provider Demographics
NPI:1689772071
Name:REDDY, BHASKARA G (MD)
Entity Type:Individual
Prefix:
First Name:BHASKARA
Middle Name:G
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD
Practice Address - Street 2:#101
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7901
Practice Address - Country:US
Practice Address - Phone:916-691-5915
Practice Address - Fax:916-691-5916
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA34089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340890Medicaid
CA00A340890Medicaid
00A340890Medicare ID - Type Unspecified
CA00A340892Medicare PIN