Provider Demographics
NPI:1538267778
Name:PRATHIPATI, KUMARA S (MD)
Entity type:Individual
Prefix:DR
First Name:KUMARA
Middle Name:S
Last Name:PRATHIPATI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4276 54TH PL STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6011
Mailing Address - Country:US
Mailing Address - Phone:619-286-3222
Mailing Address - Fax:619-286-3223
Practice Address - Street 1:502 EUCLID AVE
Practice Address - Street 2:203
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2931
Practice Address - Country:US
Practice Address - Phone:619-267-0552
Practice Address - Fax:619-286-3223
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-07-28
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Provider Licenses
StateLicense IDTaxonomies
CAA40438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50433Medicare UPIN