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NPI Code Detail

MEDICARE: KEERTHANA PRAKASH

MEDICARE: KEERTHANA PRAKASH
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1760325617
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEERTHANA PRAKASH
Provider Business Mailing Address
First Line : 1117 E DEVONSHIRE AVE
Second Line :
City : HEMET
State : CA
Zip : 92543-3083
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1117 E DEVONSHIRE AVE
Second Line :
City : HEMET
State : CA
Zip : 92543-3083
Country : US
Telephone Number : 951-652-2811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ KEERTHANA PRAKASH ” Practice Location

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