1154008167 NPI number — ANITA M. PRAKASH, M.D., F.A.C.C., PC

Table of content: (NPI 1154008167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154008167 NPI number — ANITA M. PRAKASH, M.D., F.A.C.C., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANITA M. PRAKASH, M.D., F.A.C.C., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154008167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 EL CAMINO REAL STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-697-7643
Provider Business Mailing Address Fax Number:
650-697-7895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 EL CAMINO REAL STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGAME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94010-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-697-7643
Provider Business Practice Location Address Fax Number:
650-697-7895
Provider Enumeration Date:
06/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GRANDE
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
650-697-7643

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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