| Mallu Reddy, M.d. Inc. | |
|
1196 N Park Ave Pomona CA 91768-3027 | |
| (909) 623-4050 | |
| Not Available |
| Full Name | Mallu Reddy, M.d. Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1196 N Park Ave, Pomona, California |
| Authorized Official Name and Position | Mallu Reddy (OWNER) |
| Authorized Official Contact | 9092949499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mallu Reddy, M.d. Inc. 2431 Elizabeth Ct Upland CA 91784-1311 Ph: (909) 623-4050 | Mallu Reddy, M.d. Inc. 1196 N Park Ave Pomona CA 91768-3027 Ph: (909) 623-4050 |
| NPI Number | 1184821340 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 02/19/2013 |
| Medicare PECOS PAC ID | 8022193994 |
|---|---|
| Medicare Enrollment ID | O20080317000645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184821340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A62958 (California) | Primary |
| Provider Name | Mallu C Reddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942278221 PECOS PAC ID: 7517940273 Enrollment ID: I20040615001841 |
| Provider Name | Beverly S Botnick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790754455 PECOS PAC ID: 4082636303 Enrollment ID: I20051229000370 |
| Provider Name | Venkata Subba Reddy Pulakanti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356521843 PECOS PAC ID: 7113937913 Enrollment ID: I20071024000362 |
| Provider Name | Subhash C Varshney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346359049 PECOS PAC ID: 1355498148 Enrollment ID: I20090414000338 |
| Provider Name | Evan T Geise |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215345194 PECOS PAC ID: 7719269091 Enrollment ID: I20170120002229 |
| Provider Name | Vishal Govil |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851751853 PECOS PAC ID: 7315293206 Enrollment ID: I20180706002611 |
| Provider Name | Alexandra Interiano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144663873 PECOS PAC ID: 5395178164 Enrollment ID: I20191209002088 |
| Provider Name | Christian J Custodio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811502404 PECOS PAC ID: 0648683789 Enrollment ID: I20210108000940 |
| Provider Name | Erica Natalie Michelle Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194449439 PECOS PAC ID: 3173985751 Enrollment ID: I20230814002686 |
| Provider Name | Jose De Jesus Macias-zacarias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336910744 PECOS PAC ID: 7911442330 Enrollment ID: I20240710002011 |
| Provider Name | Marvin Gil Manalo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437971561 PECOS PAC ID: 5799212130 Enrollment ID: I20241223002969 |
| Provider Name | Jane N Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679322184 PECOS PAC ID: 3779010012 Enrollment ID: I20241226002230 |
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