Provider Demographics
NPI:1245672633
Name:D. REDDY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:D. REDDY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DHARMAVIJAYPAL
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:NARAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-699-2740
Mailing Address - Street 1:17 NAPOLEON RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2715
Mailing Address - Country:US
Mailing Address - Phone:760-699-2740
Mailing Address - Fax:760-406-4217
Practice Address - Street 1:1401 N PALM CANYON DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4434
Practice Address - Country:US
Practice Address - Phone:760-699-2740
Practice Address - Fax:760-406-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A901190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI34966Medicare UPIN
CA00A901190Medicare PIN