Provider Demographics
NPI:1558945105
Name:PROSPER RAINBOW PEDIATRICS
Entity Type:Organization
Organization Name:PROSPER RAINBOW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-900-6552
Mailing Address - Street 1:27045 E UNIVERSITY DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2746
Mailing Address - Country:US
Mailing Address - Phone:469-777-4929
Mailing Address - Fax:
Practice Address - Street 1:27045 E UNIVERSITY DR STE 1B
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-2746
Practice Address - Country:US
Practice Address - Phone:469-777-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty