Provider Demographics
NPI:1902845373
Name:KOLAVALA, JANARDHANA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:JANARDHANA
Middle Name:REDDY
Last Name:KOLAVALA
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 1:18523 CORWIN ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307
Mailing Address - Country:US
Mailing Address - Phone:760-242-3634
Mailing Address - Fax:760-242-2119
Practice Address - Street 1:18523 CORWIN ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-242-3634
Practice Address - Fax:760-242-3634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38782207R00000X, 207RP1001X
CAA37882207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A387820Medicaid
CA00A387820Medicare ID - Type Unspecified
CA00A387820Medicaid