MEDICARE: RESHMINA PRASAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101Y00000X	OTHER	CA	EDGEWOOD

General Provider Information

NPI Number	:	1356661409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RESHMINA PRASAD

Provider Business Mailing Address
First Line	:	931 SAN BRUNO AVENUE,
Second Line	:	SUITE 1
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-3435
Country	:	US
Telephone Number	:	415-375-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 SAN BRUNO AVE W RM 1
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-3435
Country	:	US
Telephone Number	:	415-375-7626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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Directions to “ RESHMINA PRASAD ” Practice Location

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