Organization
DIVAKAR KRISHNAREDDY MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVAKAR KRISHNAREDDY MD (PRESIDENT)
(661) 435-9049
Entity
Organization
Contact information
Practice address
120 S MONTEBELLO BLVD, MONTEBELLO, CA 90640-4730
(661) 435-9049
(323) 443-3601
Mailing address
120 S MONTEBELLO BLVD, MONTEBELLO, CA 90640-4730
(661) 435-9049
(323) 443-3601
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A35665
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871538710
PERSONAL NPI
CA
Enumeration date
05/28/2009
Last updated
02/07/2011
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