Provider Demographics
NPI:1144475583
Name:ANUMANDLA, ANIL REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:ANIL REDDY
Middle Name:
Last Name:ANUMANDLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 W MORTON AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3383
Mailing Address - Country:US
Mailing Address - Phone:559-793-4123
Mailing Address - Fax:559-793-4120
Practice Address - Street 1:557 W MORTON AVE UNIT C
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3383
Practice Address - Country:US
Practice Address - Phone:559-793-4123
Practice Address - Fax:559-793-4120
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC176590207RC0000X
FLME150488390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease