Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 35-072256P | OH |
Y | 207K00000X | Allergist & Immunologist | C52581 | CA |
N | 207K00000X | Allergist & Immunologist | MD-045281-L | PA |
NPI | 1053300251 |
---|---|
Provider Name | Dr. Sumana Reddy |
First Address | Santee, CA 92071-5919 |
Second Address | Santee, CA 92071-5919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2084793 | (05) | OH |
C52581 | MEDICAL LICENSE (01) | CA |
F44002 | (02) | OH |
GN258A | MEDICARE GROUP PTAN (01) | CA |