Provider Demographics
NPI:1295705606
Name:REDDY, MUNI NANJUNDA (MD)
Entity type:Individual
Prefix:
First Name:MUNI
Middle Name:NANJUNDA
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 1:44 RANCHERO RD
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1031
Mailing Address - Country:US
Mailing Address - Phone:805-583-0944
Mailing Address - Fax:805-583-0155
Practice Address - Street 1:2925 SYCAMORE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1208
Practice Address - Country:US
Practice Address - Phone:805-583-0944
Practice Address - Fax:805-526-0417
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37982OtherSTATE LICENSE
CAWA37982BMedicare PIN
CAA28500Medicare UPIN