Provider Demographics
NPI:1881941003
Name:MUTYALA, RAVICHANDRA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:RAVICHANDRA
Middle Name:REDDY
Last Name:MUTYALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2185 CITRACADO PKWY
Mailing Address - Street 2:CEP AMERICA
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4159
Mailing Address - Country:US
Mailing Address - Phone:442-281-4047
Mailing Address - Fax:760-480-0194
Practice Address - Street 1:2185 CITRACADO PKWY
Practice Address - Street 2:CEP AMERICA
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:442-281-4047
Practice Address - Fax:760-480-0194
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2021-12-03
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Provider Licenses
StateLicense IDTaxonomies
CAA127221207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine