Provider Demographics
NPI:1184722183
Name:REDDY, MOHAN P
Entity type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:P
Last Name:REDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WEST OLIVE AVE.
Mailing Address - Street 2:STE. 103
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2436
Mailing Address - Country:US
Mailing Address - Phone:209-383-6868
Mailing Address - Fax:209-383-0760
Practice Address - Street 1:750 WEST OLIVE AVE.
Practice Address - Street 2:STE. 103
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2436
Practice Address - Country:US
Practice Address - Phone:209-383-6868
Practice Address - Fax:209-383-0760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA262450207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262450Medicaid
CAA24779Medicare UPIN
CA00A262450Medicare PIN