Individual
DR. MALLAREDDY MADDULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 E MARCH LN, SUITE B265, STOCKTON, CA 95210-6629
(209) 546-1868
(209) 461-6505
Mailing address
1801 E MARCH LN, SUITE B265, STOCKTON, CA 95210-6629
(209) 546-1868
(209) 461-6505
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A108120
CA
207RN0300X
Nephrology Physician
ME96158
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A108120
STATE LICENSE
CA
01
—
CB971Z
MEDICARE
CA
Enumeration date
08/28/2006
Last updated
02/28/2011
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