Basic Information
| Provider Information | |||||||||
| NPI: | 1083813331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAIDU | ||||||||
| FirstName: | MADHAVI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 WEST REDLANDS | ||||||||
| Address2: | FLOOR 2 | ||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923733145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098900407 | ||||||||
| FaxNumber: | 9098900575 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 N. MT VERNON AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924112661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098849091 | ||||||||
| FaxNumber: | 9093837013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301087417 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A157164 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.