Provider Demographics
NPI:1164464137
Name:BHATIA, PRAKASH K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:K
Last Name:BHATIA
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 1:610 EUCLID AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2951
Mailing Address - Country:US
Mailing Address - Phone:619-267-9257
Mailing Address - Fax:619-267-9273
Practice Address - Street 1:610 EUCLID AVE STE 200
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-267-9257
Practice Address - Fax:619-267-9273
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA748482084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A748480Medicaid
CA00A748480Medicaid