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General NPI Number Information
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NPI Number | 1225833742
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Entity Type | Organization
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Legal Business Name | HEALTHY KIDS PEDIATRICS
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 9481 PITTSBURGH AVE STE 200
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-9021
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Country | US
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Telephone | 909-655-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 9481 PITTSBURGH AVE STE 200
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-9021
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Country | US
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Telephone | 909-655-0300
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. PRASHANTH PORAYETTE
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Credential | MD
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Telephone | 317-709-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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