Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R76840 | AZ |
N | 111NI0900X | Internist | R76840 | AZ |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A164044 | CA |
NPI | 1043700735 |
---|---|
Provider Name | Nitin K Prabhakar |
First Address | Redwood City, CA 94063-3132 |
Second Address | Redwood City, CA 94063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 28/10/2019 |