Provider Demographics
NPI:1891159372
Name:ITALIYA, PRACHI JAIN (DO)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:JAIN
Last Name:ITALIYA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5846 WOOLDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2402
Mailing Address - Country:US
Mailing Address - Phone:361-994-8979
Mailing Address - Fax:361-994-8966
Practice Address - Street 1:5846 WOOLDRIDGE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2402
Practice Address - Country:US
Practice Address - Phone:361-994-8979
Practice Address - Fax:361-994-8966
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR6418207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine