Provider Demographics
NPI:1780652073
Name:REDDY, RADHA THIRUVENGADAM (MD)
Entity type:Individual
Prefix:
First Name:RADHA
Middle Name:THIRUVENGADAM
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 1:820 DEEP SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1448
Mailing Address - Country:US
Mailing Address - Phone:909-561-6627
Mailing Address - Fax:
Practice Address - Street 1:820 DEEP SPRINGS DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1448
Practice Address - Country:US
Practice Address - Phone:909-561-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69719207RE0101X
KY58763207RE0101X
CAA89463207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A894630Medicaid
F96235Medicare UPIN
CAF96235Medicare ID - Type Unspecified