Provider Demographics
NPI:1184245516
Name:MOHANAKRISHNAN, BALAJI PRASAD ELLAPP (MD)
Entity type:Individual
Prefix:DR
First Name:BALAJI PRASAD ELLAPP
Middle Name:
Last Name:MOHANAKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:
Other - Last Name:KRISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11234 ANDERSON STREET
Mailing Address - Street 2:MC 1503A, PCCM DEPARTMENT
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:806-414-9100
Mailing Address - Fax:412-987-6877
Practice Address - Street 1:1400 S. COULTER STREET
Practice Address - Street 2:SUITE 2500
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9100
Practice Address - Fax:806-354-5717
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine