Provider Demographics
NPI:1902874761
Name:PRABHAKAR, VEENA (DO)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51066
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5366
Mailing Address - Country:US
Mailing Address - Phone:760-745-2000
Mailing Address - Fax:760-745-0451
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:411
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-745-2000
Practice Address - Fax:760-745-0451
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH51774Medicare UPIN
CAW20A7432AMedicare ID - Type Unspecified