| NPI | 1144628504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINAY MOOLA REDDY Md/President 916-772-5325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 00A63460) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: CA 00A63460) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 00A83749) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: CA 00A83749) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA 00A63460) | |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2019-06-11 |