Provider Demographics
NPI:1518377217
Name:LECOURT, AMARATEEDHA PRAK (MD)
Entity Type:Individual
Prefix:
First Name:AMARATEEDHA
Middle Name:PRAK
Last Name:LECOURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMARATEEDHA
Other - Middle Name:
Other - Last Name:PRAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1702 BLACKBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5008
Mailing Address - Country:US
Mailing Address - Phone:727-612-6089
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:4TH FLOOR, RM 4172
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-719-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA179332207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program