Provider Demographics
NPI:1215931761
Name:PRAKASH, RAVI (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4305 TORRANCE BLVD
Mailing Address - Street 2:STE 405
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4407
Mailing Address - Country:US
Mailing Address - Phone:310-214-5433
Mailing Address - Fax:310-214-4103
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:STE 405
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4407
Practice Address - Country:US
Practice Address - Phone:310-214-5433
Practice Address - Fax:310-214-4103
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2011-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24001Medicare UPIN