Healthcare Provider Details

I. General information

NPI: 1720549405
Provider Name (Legal Business Name): PRASHANTH VENKATARAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DUBOCE AVE STE 175A
SAN FRANCISCO CA
94117-3389
US

IV. Provider business mailing address

605 E EVELYN AVE UNIT 6441
MOUNTAIN VIEW CA
94041-1573
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5760
  • Fax: 415-369-1208
Mailing address:
  • Phone: 919-623-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA180746
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA180746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: