Provider Demographics
NPI:1932211950
Name:KOMMAREDDY, SUMITHRA (MD)
Entity type:Individual
Prefix:MISS
First Name:SUMITHRA
Middle Name:
Last Name:KOMMAREDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1128 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1878
Mailing Address - Country:US
Mailing Address - Phone:626-398-7770
Mailing Address - Fax:626-296-2956
Practice Address - Street 1:309 W BEVERLY BLVD
Practice Address - Street 2:C/O NICU
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4308
Practice Address - Country:US
Practice Address - Phone:323-725-4331
Practice Address - Fax:323-889-2483
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA436892080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine