Provider Demographics
NPI:1891751475
Name:PRABHU, RAVINDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:
Last Name:PRABHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6654
Mailing Address - Country:US
Mailing Address - Phone:619-482-4333
Mailing Address - Fax:619-482-4445
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 203
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6654
Practice Address - Country:US
Practice Address - Phone:619-482-4333
Practice Address - Fax:619-482-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37174207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371740Medicaid
CAA28322Medicare UPIN
A37174Medicare ID - Type Unspecified