Healthcare Provider Details

I. General information

NPI: 1336259670
Provider Name (Legal Business Name): NARAKESARI PRASANNA HERAGU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL CARDIOLOGY
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6257
  • Fax: 559-353-5455
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberC51536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: