Healthcare Provider Details

I. General information

NPI: 1144957309
Provider Name (Legal Business Name): CHERUBA PRABAKAR MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 2ND ST STE 100
LAFAYETTE CA
94549-4544
US

IV. Provider business mailing address

5676 OAK GROVE AVE
OAKLAND CA
94618-1243
US

V. Phone/Fax

Practice location:
  • Phone: 925-403-4610
  • Fax:
Mailing address:
  • Phone: 203-232-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERUBA PRABAKAR
Title or Position: CEO
Credential: MD
Phone: 203-232-2762