Basic Information
| Provider Information | |||||||||
| NPI: | 1194970814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHALLA | ||||||||
| FirstName: | PRASANNA | ||||||||
| MiddleName: | KUMARI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15243 VANOWEN ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187825041 | ||||||||
| FaxNumber: | 8182059091 | ||||||||
| Practice Location | |||||||||
| Address1: | 14901 RINALDI ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183651339 | ||||||||
| FaxNumber: | 8188984301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2008 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 40353 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 2005-01610 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | A126159 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.