=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740253228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRANEETHA REDDY NARAHARI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2006
-----------------------------------------------------
Last Update Date | 07/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 E HERNDON AVE STE 210
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-450-7200
-----------------------------------------------------
Fax | 559-450-7214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 E SPRUCE AVE SUITE 201
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-450-7200
-----------------------------------------------------
Fax | 559-450-7214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 152162
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A66871
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------