Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A82683 | CA |
N | 111NI0900X | Internist | A82683 | CA |
N | 207RG0300X | Geriatric Medicine | A82683 | CA |
Y | 207RI0200X | Infectious Disease | A82683 | CA |
N | 207RI0200X | Infectious Disease | ME88635 | FL |
NPI | 1083610703 |
---|---|
Provider Name | Dr. Jagadeesh C Reddy |
First Address | Laguna Hills, CA 92653-6306 |
Second Address | Laguna Beach, CA 92651-6765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 27/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269550200 | (05) | FL |
H83660 | (02) | FL |