Provider Demographics
NPI:1457748840
Name:REDDY, PAVAN (MD)
Entity type:Individual
Prefix:
First Name:PAVAN
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1380 EL CAJON BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5760
Mailing Address - Country:US
Mailing Address - Phone:619-867-0557
Mailing Address - Fax:619-867-0558
Practice Address - Street 1:1380 EL CAJON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5760
Practice Address - Country:US
Practice Address - Phone:619-867-0557
Practice Address - Fax:619-867-0558
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA146837207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty