Provider Demographics
NPI:1316274566
Name:REDDY, DHURGA SYAMALA (ND)
Entity type:Individual
Prefix:DR
First Name:DHURGA
Middle Name:SYAMALA
Last Name:REDDY
Suffix:
Gender:F
Credentials:ND
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Other - Credentials:
Mailing Address - Street 1:1831 ORANGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2839
Mailing Address - Country:US
Mailing Address - Phone:949-574-4978
Mailing Address - Fax:949-574-9854
Practice Address - Street 1:1831 ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-574-4978
Practice Address - Fax:949-574-9854
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-381175F00000X
CAND381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No175F00000XOther Service ProvidersNaturopath