MEDICARE: RONIKA RANJITA PRAKASH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	R1458340222	CA
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1457521205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONIKA RANJITA PRAKASH

Provider Business Mailing Address
First Line	:	9620 PEWTER CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-4465
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 SPAANS DR
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-8609
Country	:	US
Telephone Number	:	916-385-1701
Fax Number	:

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

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	02/17/2022

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