Provider Demographics
NPI:1326558891
Name:PRABHU LOHARUKA, M.D.
Entity Type:Organization
Organization Name:PRABHU LOHARUKA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABHU
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHARUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-5676
Mailing Address - Street 1:4201 TORRANCE BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4501
Mailing Address - Country:US
Mailing Address - Phone:310-540-5676
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD STE 380
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4501
Practice Address - Country:US
Practice Address - Phone:310-540-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841395993OtherMEDICARE