Provider Demographics
NPI:1891086948
Name:REDDY, ANJANI T (MD)
Entity Type:Individual
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First Name:ANJANI
Middle Name:T
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-319-4700
Mailing Address - Fax:310-453-5676
Practice Address - Street 1:1920 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3414
Practice Address - Country:US
Practice Address - Phone:310-319-4700
Practice Address - Fax:310-453-5376
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2012-02-09
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Provider Licenses
StateLicense IDTaxonomies
CAA115706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891086948Medicaid
CA1891086948OtherCALIFORNIA CHILDRENS SERVICES (CCS) PANELED
CAFM416ZMedicare PIN