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General NPI Number Information
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NPI Number | 1255934014
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Entity Type | Individual
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Provider Name | MANOGJNA RUTH PRASAD MD
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1215 N BEAVER ST STE 203
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3120
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Country | US
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Telephone | 928-773-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 V ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-1460
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Country | US
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Telephone | 916-734-3730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 75397
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A189776
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License Number State | CA
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