Provider Demographics
NPI:1356661409
Name:PRASAD, RESHMINA
Entity Type:Individual
Prefix:
First Name:RESHMINA
Middle Name:
Last Name:PRASAD
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 1:931 SAN BRUNO AVENUE,
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3435
Mailing Address - Country:US
Mailing Address - Phone:415-375-7626
Mailing Address - Fax:
Practice Address - Street 1:931 SAN BRUNO AVE W RM 1
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3435
Practice Address - Country:US
Practice Address - Phone:415-375-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XOtherEDGEWOOD