Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 125063415 | IL |
N | 2081P2900X | Pain Medicine | A147522 | CA |
NPI | 1053653493 |
---|---|
Provider Name | Mr. Rajiv D Reddy |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 15/06/2018 |