Healthcare Provider Details

I. General information

NPI: 1154379147
Provider Name (Legal Business Name): PRABHDEEP S SETHI M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E HIGHLAND AVE SUITE 307
SAN BERNARDINO CA
92404-3808
US

IV. Provider business mailing address

399 E HIGHLAND AVE SUITE 307
SAN BERNARDINO CA
92404-3808
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-7400
  • Fax: 909-881-5217
Mailing address:
  • Phone: 909-881-7400
  • Fax: 909-881-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC53198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC53198
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberC53198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: