MEDICARE: DR. ADITYA SUDNAGUNTA PRASAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	A103484	CA
2	207RC0000X	Cardiovascular Disease Physician	48210	AZ
3	207RC0000X	Cardiovascular Disease Physician	A103484	CA

General Provider Information

NPI Number	:	1154580074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADITYA SUDNAGUNTA PRASAD M.D.

Provider Business Mailing Address
First Line	:	17360 BROOKHURST ST
Second Line	:	ATTN: CREDENTIALING DEPARTMENT
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3828 SCHAUFELE AVE STE 250
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1793
Country	:	US
Telephone Number	:	657-241-8990
Fax Number	:	714-665-4664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	04/30/2026

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