Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A36428 | CA |
NPI | 1063418630 |
---|---|
Provider Name | Mr. Moola Prabhakar Reddy |
First Address | Granite Bay, CA 95746-8850 |
Second Address | Roseville, CA 95661-3047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 03/02/2015 |