Provider Demographics
NPI:1447286489
Name:REDDY, SRAVANTHI (MD)
Entity type:Individual
Prefix:
First Name:SRAVANTHI
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRAVANTHI
Other - Middle Name:REDDY
Other - Last Name:KEESARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8541
Mailing Address - Fax:323-442-8755
Practice Address - Street 1:1500 SAN PABLO ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:323-442-8755
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG737402085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG73740HMedicare PIN
CAWG73740CMedicare PIN
CAB50204Medicare UPIN
CAWG73740DMedicare PIN
CAWG73740JMedicare PIN
CAWG73740GMedicare PIN
CAWG73740EMedicare PIN
CAWG73740JMedicare PIN
CA300083111OtherRAIL ROAD MEDICARE
CA00G737400G56OtherCAL OPTIMA
CAWG73740EMedicare PIN