Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 53832 | AZ |
NPI | 1174838528 |
---|---|
Provider Name | Dr. Deepa Prasad |
First Address | Mesa, AZ 85202-4768 |
Second Address | Mesa, AZ 85202-4768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 29/08/2019 |