Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | A106189 | CA |
NPI | 1053576066 |
---|---|
Provider Name | Dr. Shraddha Prakash |
First Address | San Leandro, CA 94577-4201 |
Second Address | San Leandro, CA 94577-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2008 |
Last Update Date | 06/12/2016 |