Basic Information
Provider Information
NPI: 1811487432
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REDDY
FirstName: AUROSIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1155 MILL ST # MCM14
Address2:  
City: RENO
State: NV
PostalCode: 895021576
CountryCode: US
TelephoneNumber: 7752982052
FaxNumber: 7759823900
Practice Location
Address1: 2300 S CARSON ST STE 1
Address2:  
City: CARSON CITY
State: NV
PostalCode: 897014528
CountryCode: US
TelephoneNumber: 7759825000
FaxNumber: 7759823900
Other Information
ProviderEnumerationDate: 05/18/2018
LastUpdateDate: 06/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XDO2944NVY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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