Provider Demographics
NPI:1205229564
Name:PRAKASH, AANCHAL
Entity Type:Individual
Prefix:
First Name:AANCHAL
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 E OHIO ST
Practice Address - Street 2:APT 31G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3390
Practice Address - Country:US
Practice Address - Phone:408-540-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159366207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology