Provider Demographics
NPI:1770511602
Name:REDDY, NAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVEEN
Middle Name:
Last Name:REDDY
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 1:4521 E. CESAR CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1116
Mailing Address - Country:US
Mailing Address - Phone:310-892-4232
Mailing Address - Fax:
Practice Address - Street 1:4521 E. CESAR CHAVEZ AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1116
Practice Address - Country:US
Practice Address - Phone:323-269-4509
Practice Address - Fax:323-269-4509
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75877207P00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A758770Medicaid
CAWA75877JMedicare PIN
CAWA75877IMedicare PIN
CABT299YMedicare PIN
G79318Medicare UPIN
CA00A758770Medicaid