Provider Demographics
NPI:1144957309
Name:CHERUBA PRABAKAR MD, INC
Entity type:Organization
Organization Name:CHERUBA PRABAKAR MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRABAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-232-2762
Mailing Address - Street 1:5676 OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1243
Mailing Address - Country:US
Mailing Address - Phone:203-232-2762
Mailing Address - Fax:
Practice Address - Street 1:978 2ND ST STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4544
Practice Address - Country:US
Practice Address - Phone:925-403-4610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty