Provider Demographics
NPI:1992760763
Name:KRISHNAMSHETTY, PRASANNA L (MD)
Entity type:Individual
Prefix:
First Name:PRASANNA
Middle Name:L
Last Name:KRISHNAMSHETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE# 435
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-258-4244
Mailing Address - Fax:408-258-3338
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:STE# 435
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-258-4244
Practice Address - Fax:408-258-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA63379173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR09174OtherBLUE CROSS
CA7396695OtherAETNA
CA00A633791OtherMEDI-CAL