Provider Demographics
NPI:1154008167
Name:ANITA M. PRAKASH, M.D., F.A.C.C., PC
Entity type:Organization
Organization Name:ANITA M. PRAKASH, M.D., F.A.C.C., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-697-7643
Mailing Address - Street 1:1750 EL CAMINO REAL STE 11
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3208
Mailing Address - Country:US
Mailing Address - Phone:650-697-7643
Mailing Address - Fax:650-697-7895
Practice Address - Street 1:1750 EL CAMINO REAL STE 11
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3208
Practice Address - Country:US
Practice Address - Phone:650-697-7643
Practice Address - Fax:650-697-7895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANITA M. PRAKASH, M.D., F.A.C.C., PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty