Provider Demographics
NPI:1821007709
Name:REDDY, ROOPA (MD)
Entity type:Individual
Prefix:MRS
First Name:ROOPA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 W. SIXTH STREET
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-547-9922
Mailing Address - Fax:310-547-4673
Practice Address - Street 1:1360 W. SIXTH STREET
Practice Address - Street 2:STE. 200
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-547-9922
Practice Address - Fax:310-547-4673
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG73759IMedicare ID - Type Unspecified
CAWG73759DMedicare ID - Type Unspecified
CAF48296Medicare UPIN
CAWG73759GMedicare ID - Type Unspecified
CAWG73759CMedicare ID - Type Unspecified
CAWG73759KMedicare ID - Type Unspecified