Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 01045025A | IN |
N | 207RG0100X | Gastroenterologist | 036093840 | IL |
Y | 207RG0100X | Gastroenterologist | A44374 | CA |
N | 207RG0100X | Gastroenterologist | MD00034669 | WA |
NPI | 1033221007 |
---|---|
Provider Name | Jyothi Ahalya Reddy |
First Address | Riverside, CA 92503-3684 |
Second Address | Riverside, CA 92503-3684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 18/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036093840 | (05) | IL |
212139 | (02) | IL |
213500 | (02) | IL |