Provider Demographics
NPI:1730065525
Name:JAKKIREADY, PRUDVI RAMREDDY
Entity type:Individual
Prefix:
First Name:PRUDVI RAMREDDY
Middle Name:
Last Name:JAKKIREADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630E IMPERIAL HIGHWAY, LYNWOOD CA 90262
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-900-8524
Mailing Address - Fax:
Practice Address - Street 1:3630E IMPERIAL HIGHWAY, LYNWOOD CA 90262
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-900-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program