| Prodigy Psychiatric Group | |
|
5791 Capilano Dr San Jose CA 95138-2364 | |
| (408) 630-1209 | |
| Not Available |
| Full Name | Prodigy Psychiatric Group |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 5791 Capilano Dr, San Jose, California |
| Authorized Official Name and Position | Beeta R Verma (PRESIDENT) |
| Authorized Official Contact | 5108757721 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prodigy Psychiatric Group 5791 Capilano Dr San Jose CA 95138-2364 Ph: (510) 875-7721 | Prodigy Psychiatric Group 5791 Capilano Dr San Jose CA 95138-2364 Ph: (408) 630-1209 |
| NPI Number | 1255990768 |
|---|---|
| Provider Enumeration Date | 06/08/2019 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255990768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
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