1124220181 NPI number — SAN DIEGO INSTITUTE OF GASTROENTEROLOGY AND NUTRITION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124220181 NPI number — SAN DIEGO INSTITUTE OF GASTROENTEROLOGY AND NUTRITION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN DIEGO INSTITUTE OF GASTROENTEROLOGY AND NUTRITION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124220181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6699 ALVARADO RD
Provider Second Line Business Mailing Address:
SUITE 2301
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120-5244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-229-1005
Provider Business Mailing Address Fax Number:
619-326-0380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6699 ALVARADO RD
Provider Second Line Business Practice Location Address:
SUITE 2301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-1005
Provider Business Practice Location Address Fax Number:
619-326-0380
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
ANANTHRAM
Authorized Official Middle Name:
POTTIPATI
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
619-229-1005

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  2955846 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C52423 . This is a "MEDICAL LICENSE- ANANTHRAM REDDY, MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A46472 . This is a "MEDICAL LICENSE- JOSEPH B. REDDY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A464720 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C524230 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A46472 . This is a "MEDICAL LICENSE - JOSEPH REDDY, MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C52423 . This is a "MEDICAL LICENSE -ANANTHRAM P. REDDY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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