Provider Demographics
NPI:1225021587
Name:SINGH, PRABHDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHDEEP
Middle Name:
Last Name:SINGH
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 1:2061 ROSS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3687
Mailing Address - Country:US
Mailing Address - Phone:760-352-5800
Mailing Address - Fax:760-545-0249
Practice Address - Street 1:2061 ROSS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3687
Practice Address - Country:US
Practice Address - Phone:760-352-5800
Practice Address - Fax:760-545-0249
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560530Medicaid
CACC6635OtherRAILROAD GROUP #
CAZZZ47480ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ47480ZOtherBLUE SHIELD OF CALIFORNIA
CAG34373Medicare UPIN
CAWA56053AMedicare PIN
CAW13536BMedicare PIN
CAP00462174Medicare PIN
CAW13536Medicare PIN