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General NPI Number Information
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NPI Number | 1154008167
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Entity Type | Organization
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Legal Business Name | ANITA M. PRAKASH, M.D., F.A.C.C., PC
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1750 EL CAMINO REAL STE 11
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City | BURLINGAME
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State | CA
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Zip | 94010-3208
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Country | US
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Telephone | 650-697-7643
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Fax | 650-697-7895
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Provider Business Mailing Address
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Address Line | 1750 EL CAMINO REAL STE 11
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City | BURLINGAME
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State | CA
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Zip | 94010-3208
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Country | US
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Telephone | 650-697-7643
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Fax | 650-697-7895
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MARIA ELIZABETH GRANDE
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Credential |
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Telephone | 650-697-7643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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