Provider Demographics
NPI:1578578050
Name:PRAKASH, ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 ALTOS OAKS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5426
Mailing Address - Country:US
Mailing Address - Phone:650-823-0222
Mailing Address - Fax:650-917-6925
Practice Address - Street 1:811 ALTOS OAKS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5426
Practice Address - Country:US
Practice Address - Phone:650-823-0222
Practice Address - Fax:650-917-6925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84854207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098530Medicaid
CAGR0098530Medicaid
CAZZZ86934ZMedicare ID - Type Unspecified