Provider Demographics
NPI:1306869300
Name:REDDY, JYOTHI J (MD)
Entity type:Individual
Prefix:MRS
First Name:JYOTHI
Middle Name:J
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 FAIRMOUNT AVE
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105
Mailing Address - Country:US
Mailing Address - Phone:619-255-9154
Mailing Address - Fax:619-795-9847
Practice Address - Street 1:4060 FAIRMOUNT AVE.
Practice Address - Street 2:PEDIATRICS DEPARTMENT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-255-9154
Practice Address - Fax:619-795-9847
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2825208000000X
CAC144069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
25622OtherTHE AMERICAN BOARD OF PEDIATRICS
TX133349408Medicaid