Healthcare Provider Details

I. General information

NPI: 1487687661
Provider Name (Legal Business Name): VIBHAY PRASAD, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LA VENTA DR SUITE 104
WESTLAKE VILLAGE CA
91361-3703
US

IV. Provider business mailing address

PO BOX 90125
LONG BEACH CA
90809-0125
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-4020
  • Fax: 805-496-4030
Mailing address:
  • Phone: 800-404-2353
  • Fax: 562-795-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG75764
License Number StateCA

VIII. Authorized Official

Name: VIBHAY PRASAD
Title or Position: OWNER
Credential: M.D.
Phone: 805-496-4020