Healthcare Provider Details

I. General information

NPI: 1023916962
Provider Name (Legal Business Name): PRAKASH V GEORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 103937 PASADENA PASADENA, CA 91189
PASADENA CA
91189-3937
US

IV. Provider business mailing address

PO BOX 103937 PASADENA, CA 91189
PASADENA CA
91189-3937
US

V. Phone/Fax

Practice location:
  • Phone: 760-330-5327
  • Fax: 619-330-6547
Mailing address:
  • Phone: 619-330-6547
  • Fax: 619-330-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: