Provider Demographics
NPI:1487687661
Name:VIBHAY PRASAD, M.D., INC
Entity Type:Organization
Organization Name:VIBHAY PRASAD, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIBHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-4020
Mailing Address - Street 1:PO BOX 90125
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-0125
Mailing Address - Country:US
Mailing Address - Phone:800-404-2353
Mailing Address - Fax:562-795-0676
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-496-4020
Practice Address - Fax:805-496-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75764208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G757640Medicaid
CAG75764AMedicare ID - Type Unspecified
CA00G757640Medicaid