Basic Information
| Provider Information | |||||||||
| NPI: | 1114919255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | MALINI | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | REDDY | ||||||||
| OtherFirstName: | MALINI | ||||||||
| OtherMiddleName: | VENKATA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16955 VIA DEL CAMPO | ||||||||
| Address2: | STE 215 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586736100 | ||||||||
| FaxNumber: | 8586736113 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 E VALLEY PKWY | ||||||||
| Address2: | PALOMAR MEDICAL CENTER | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607393000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 05/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A84196 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A841960 | 05 | CA | MEDICAID |