Provider Demographics
NPI:1093103681
Name:KOTAKONDA, HARI PRASAD VASISTA
Entity Type:Individual
Prefix:MR
First Name:HARI PRASAD
Middle Name:VASISTA
Last Name:KOTAKONDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 TOPANGA CANYON BLVD APT D105
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4601
Mailing Address - Country:US
Mailing Address - Phone:408-476-2990
Mailing Address - Fax:
Practice Address - Street 1:5807 TOPANGA CANYON BLVD APT D105
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:408-476-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17275235Z00000X
CAHA8060237600000X
CAAU3272231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter