Healthcare Provider Details
I. General information
NPI: 1669560231
Provider Name (Legal Business Name): PRAFUL SARODE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/10/2006
Last Update Date: 01/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
999 N TUSTIN AVE SUITE # 124
SANTA ANA CA
92705-3528
US
IV. Provider business mailing address
999 N TUSTIN AVE SUITE # 124
SANTA ANA CA
92705-3528
US
V. Phone/Fax
- Phone: 714-547-5444
- Fax:
- Phone: 714-547-5444
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | A43383 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 31704 |
| License Number State | AZ |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | A43383 |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 31704 |
| License Number State | AZ |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080N0001X |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| License Number | A43383 |
| License Number State | CA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080N0001X |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| License Number | 31704 |
| License Number State | AZ |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080P0203X |
| Taxonomy | Pediatric Critical Care Medicine Physician |
| License Number | A43383 |
| License Number State | CA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080P0203X |
| Taxonomy | Pediatric Critical Care Medicine Physician |
| License Number | 31704 |
| License Number State | AZ |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080P0214X |
| Taxonomy | Pediatric Pulmonology Physician |
| License Number | A43383 |
| License Number State | CA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080P0214X |
| Taxonomy | Pediatric Pulmonology Physician |
| License Number | 31704 |
| License Number State | AZ |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083P0011X |
| Taxonomy | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician |
| License Number | A43383 |
| License Number State | CA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083P0011X |
| Taxonomy | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician |
| License Number | 31704 |
| License Number State | AZ |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208M00000X |
| Taxonomy | Hospitalist Physician |
| License Number | A43383 |
| License Number State | CA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208M00000X |
| Taxonomy | Hospitalist Physician |
| License Number | 31704 |
| License Number State | AZ |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
