Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A122438 | CA |
NPI | 1003058207 |
---|---|
Provider Name | Sireesha Indupuru Reddy |
First Address | Fresno, CA 93721-1431 |
Second Address | Reedley, CA 93654-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2009 |
Last Update Date | 15/01/2020 |