Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | A49497 | CA |
NPI | 1073523916 |
---|---|
Provider Name | Manthani P Reddy |
First Address | Fresno, CA 93720-8008 |
Second Address | Fresno, CA 93720-8008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 15/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A494970 | (05) | CA |
F10638 | (02) | CA |