Basic Information
| Provider Information | |||||||||
| NPI: | 1881941003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUTYALA | ||||||||
| FirstName: | RAVICHANDRA | ||||||||
| MiddleName: | REDDY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 CITRACADO PKWY | ||||||||
| Address2: | CEP AMERICA | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920294159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4422814047 | ||||||||
| FaxNumber: | 7604800194 | ||||||||
| Practice Location | |||||||||
| Address1: | 2185 CITRACADO PKWY | ||||||||
| Address2: | CEP AMERICA | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920294159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4422814047 | ||||||||
| FaxNumber: | 7604800194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A127221 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A127221 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.