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NPI Code Detail

MEDICARE: MRS. VEENA PRABHAKAR D.O.

MEDICARE: MRS. VEENA PRABHAKAR D.O.
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
12084P0800XPsychiatry PhysicianOP60174488WA

General Provider Information

NPI Number : 1407045669
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VEENA PRABHAKAR D.O.
Provider Business Mailing Address
First Line : 1800 112TH AVE NE
Second Line : STE 215-E
City : BELLEVUE
State : WA
Zip : 98004-2993
Country : US
Telephone Number : 425-646-7279
Fax Number : 425-696-3310
Provider Business Practice Location Address
First Line : 3639 MARTIN LUTHER KING JR WAY S
Second Line :
City : SEATTLE
State : WA
Zip : 98144-6847
Country : US
Telephone Number : 206-695-7600
Fax Number : 206-695-7606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2007
Last Update Date : 10/26/2018

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