1477941219 NPI number — PRASHANT NAKSHATRI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477941219 NPI number — PRASHANT NAKSHATRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAKSHATRI
Provider First Name:
PRASHANT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477941219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/O K.G.NAKSHATRI, VASUKI, AMBALPADY POST
Provider Second Line Business Mailing Address:
UDUPI DIST, KARNATAKA AND INDIA
Provider Business Mailing Address City Name:
UDUPI
Provider Business Mailing Address State Name:
KARNATAKA
Provider Business Mailing Address Postal Code:
576116
Provider Business Mailing Address Country Code:
IN
Provider Business Mailing Address Telephone Number:
91-948-2044
Provider Business Mailing Address Fax Number:
12-345-6789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 W BEVERLY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-4138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-724-1315
Provider Business Practice Location Address Fax Number:
323-724-1053
Provider Enumeration Date:
01/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  16192 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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