Provider Demographics
NPI:1780709345
Name:KUMARA PRATHIPATI, M.D.,INC
Entity type:Organization
Organization Name:KUMARA PRATHIPATI, M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRATHIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-286-3222
Mailing Address - Street 1:4276 54TH PL
Mailing Address - Street 2:#B
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 1:4276 54TH PL
Practice Address - Street 2:#B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6011
Practice Address - Country:US
Practice Address - Phone:619-286-3222
Practice Address - Fax:619-286-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50433Medicare UPIN