Provider Demographics
NPI:1982616124
Name:REDDY, PAVANI NAINI (MD)
Entity Type:Individual
Prefix:
First Name:PAVANI
Middle Name:NAINI
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAVANI
Other - Middle Name:REDDY
Other - Last Name:NAINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4002 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-1068
Mailing Address - Country:US
Mailing Address - Phone:714-473-8777
Mailing Address - Fax:
Practice Address - Street 1:220 LAGUNA RD STE 2
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2523
Practice Address - Country:US
Practice Address - Phone:714-446-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88373207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine