Provider Demographics
NPI:1053300251
Name:REDDY, SUMANA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMANA
Middle Name:
Last Name:REDDY
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:SUMANA
Other - Middle Name:
Other - Last Name:REDDY-POTTIPATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:875 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5714
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:
Practice Address - Street 1:875 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5714
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-072256P207K00000X
CAC52581207K00000X
PAMD-045281-L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52581OtherMEDICAL LICENSE
CAGN258AOtherMEDICARE GROUP PTAN
OH2084793Medicaid
CAC52581OtherMEDICAL LICENSE
CAC52581OtherMEDICAL LICENSE