Healthcare Provider Details

I. General information

NPI: 1679701858
Provider Name (Legal Business Name): CHERUBA PRABAKAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

365 HAWTHORNE AVE STE 301
OAKLAND CA
94609-3107
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-3977
  • Fax: 510-204-5429
Mailing address:
  • Phone: 510-893-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA136084
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA136084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: