Provider Demographics
NPI:1568480838
Name:PRAKASH, NEAL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:626-408-3911
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-359-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA831992084N0400X
FLME1642332084N0400X
MS323752084N0400X
HI142842084N0400X
LA3390902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000287276OtherHMSA
HI595449-01Medicaid
CA00A831990OtherMEDICAL PPIN #
LA339090OtherLA LICENSE
0000287276OtherHMSA
CA00A831990OtherMEDICAL PPIN #
HI595449-01Medicaid