| Vijaya Pratha M.d. | |
|
3330 3rd Ave Ste 304 San Diego CA 92103-5639 | |
| (619) 260-1012 | |
| (619) 260-1532 |
| Full Name | Vijaya Pratha M.d. |
|---|---|
| Speciality | Internal Medicine |
| Location | 3330 3rd Ave Ste 304, San Diego, California |
| Authorized Official Name and Position | Vijayalakshmi S Pratha (OWNER) |
| Authorized Official Contact | 6192601012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vijaya Pratha M.d. 3330 3rd Ave Ste 304 San Diego CA 92103-5639 Ph: (619) 260-1012 | Vijaya Pratha M.d. 3330 3rd Ave Ste 304 San Diego CA 92103-5639 Ph: (619) 260-1012 |
| NPI Number | 1386889889 |
|---|---|
| Provider Enumeration Date | 12/11/2008 |
| Last Update Date | 09/26/2023 |
| Medicare PECOS PAC ID | 4880756410 |
|---|---|
| Medicare Enrollment ID | O20081216000483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386889889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | A51136 (California) | Primary |
| Provider Name | Vijayalak S Pratha |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1992892707 PECOS PAC ID: 6103846365 Enrollment ID: I20051201001052 |
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