Provider Demographics
NPI:1669766473
Name:REDDY, DIVYA K (MD)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:K
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9333 GENESEE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2111
Mailing Address - Country:US
Mailing Address - Phone:858-657-8600
Mailing Address - Fax:858-657-8625
Practice Address - Street 1:9333 GENESEE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2111
Practice Address - Country:US
Practice Address - Phone:858-657-8600
Practice Address - Fax:858-657-8625
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2016-11-29
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Provider Licenses
StateLicense IDTaxonomies
KS94-07693207Q00000X
CA130224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine