Basic Information
| Provider Information | |||||||||
| NPI: | 1669817987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | SRIDHAR | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13217 HANEY PL | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900493624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582430503 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4955 VAN NUYS BLVD STE 308 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185281260 | ||||||||
| FaxNumber: | 8185281261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2013 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R74126 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | A167870 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.