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Organization

VALLEY PEDIATRIC PULMONARY MEDICAL CORP.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SUDHAKAR L. REDDIVALAM M.D. (PEDIATRIC PULMONOLOGIST)
(559) 353-5550
Entity
Organization

Contact information

Practice address
9300 VALLEY CHILDRENS PL, MADERA, CA 93638-8761
(559) 353-5550
(559) 353-5587
Mailing address
9300 VALLEY CHILDRENS PL, MADERA, CA 93638-8761
(559) 353-5550
(559) 353-5587

Taxonomy

Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
2080P0214X
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A49339
CA LICENSE #
CA
01
A49421
CA LICENSE #
CA
01
A76613
CA LICENSE #
CA
05
GR0103350
CA
Enumeration date
01/23/2007
Last updated
08/22/2020
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