MEDICARE: RAJENDRA 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	174400000X	Specialist	A25178	CA
2	207RH0000X	Hematology (Internal Medicine) Physician	A25178	CA
3	207RX0202X	Medical Oncology Physician	A25178	CA

General Provider Information

NPI Number	:	1558585323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJENDRA PRASAD M.D.

Provider Business Mailing Address
First Line	:	3650 SOUTH ST STE 212
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1528
Country	:	US
Telephone Number	:	562-272-7632
Fax Number	:	562-272-7631

Provider Business Practice Location Address
First Line	:	3650 SOUTH ST STE 212
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1528
Country	:	US
Telephone Number	:	562-272-7632
Fax Number	:	562-272-7631

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	01/16/2019

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