Provider Demographics
NPI:1740330810
Name:PRASAD D. MUMMANENI, M.D.,INC.
Entity type:Organization
Organization Name:PRASAD D. MUMMANENI, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-983-0208
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-983-0208
Mailing Address - Fax:805-981-0565
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:STE 350
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-983-0208
Practice Address - Fax:805-981-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35782207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16131Medicare ID - Type UnspecifiedGROUP ID