Provider Demographics
NPI:1437447521
Name:CENTER OF EXCELLENCE IN DIABETES AND ENDOCRINOLOGY
Entity Type:Organization
Organization Name:CENTER OF EXCELLENCE IN DIABETES AND ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GNANAGURUDASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-733-0888
Mailing Address - Street 1:3814 AUBURN BLVD
Mailing Address - Street 2:SUITE 72
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2123
Mailing Address - Country:US
Mailing Address - Phone:916-426-1902
Mailing Address - Fax:916-426-1940
Practice Address - Street 1:3814 AUBURN BLVD
Practice Address - Street 2:SUITE 72
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2123
Practice Address - Country:US
Practice Address - Phone:916-426-1902
Practice Address - Fax:916-426-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty