Provider Demographics
NPI:1447253158
Name:REDDINGTON, LURA JUSTICE (MD)
Entity type:Individual
Prefix:DR
First Name:LURA
Middle Name:JUSTICE
Last Name:REDDINGTON
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 1:6730 N WEST AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-4301
Mailing Address - Country:US
Mailing Address - Phone:559-261-9320
Mailing Address - Fax:559-261-9324
Practice Address - Street 1:6730 N WEST AVE
Practice Address - Street 2:STE 115
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-4301
Practice Address - Country:US
Practice Address - Phone:559-261-9320
Practice Address - Fax:559-261-9324
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76987207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3540026Medicaid
CAF64845Medicare UPIN
CA00G769870Medicare ID - Type Unspecified