Provider Demographics
NPI:1396710075
Name:PRABHAKAR, ARUDI L (MD)
Entity type:Individual
Prefix:DR
First Name:ARUDI
Middle Name:L
Last Name:PRABHAKAR
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 1:18231 IRVINE BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3432
Mailing Address - Country:US
Mailing Address - Phone:714-389-5700
Mailing Address - Fax:714-389-6973
Practice Address - Street 1:6136 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2502
Practice Address - Country:US
Practice Address - Phone:619-303-5500
Practice Address - Fax:619-303-5595
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A316271Medicare ID - Type Unspecified
CAA26544Medicare UPIN