Provider Demographics
NPI:1053441329
Name:VATHESATOGKIT, PRATAN (MD)
Entity Type:Individual
Prefix:
First Name:PRATAN
Middle Name:
Last Name:VATHESATOGKIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 WARING CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4510
Mailing Address - Country:US
Mailing Address - Phone:760-630-4833
Mailing Address - Fax:760-758-1980
Practice Address - Street 1:3231 WARING CT
Practice Address - Street 2:SUITE D
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4510
Practice Address - Country:US
Practice Address - Phone:760-630-4833
Practice Address - Fax:760-758-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69561207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB38005Medicare ID - Type Unspecified
BK309ZMedicare PIN
H89757Medicare UPIN