Healthcare Provider Details

I. General information

NPI: 1275548943
Provider Name (Legal Business Name): RAJEEV PRASAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NIELSON ST STE 102
WATSONVILLE CA
95076-2491
US

IV. Provider business mailing address

65 NIELSON ST STE 102
WATSONVILLE CA
95076-2491
US

V. Phone/Fax

Practice location:
  • Phone: 831-768-6217
  • Fax: 831-768-6219
Mailing address:
  • Phone: 831-768-6217
  • Fax: 831-768-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number11806
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number57397
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC128004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: