Provider Demographics
NPI:1275969982
Name:RANDEV, PRABHJOT (MBBS)
Entity Type:Individual
Prefix:
First Name:PRABHJOT
Middle Name:
Last Name:RANDEV
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-637-2499
Practice Address - Street 1:5542 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-637-2499
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2020-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR0105208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275969982OtherNPI