Provider Demographics
NPI:1134131725
Name:KARNIK, PRACHI AVINASH (MD)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:AVINASH
Last Name:KARNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4994
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:619-441-6349
Practice Address - Street 1:1240 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4994
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:619-441-6349
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A832280Medicaid
CA00A832280Medicaid
CAI103701Medicare UPIN