Basic Information
| Provider Information | |||||||||
| NPI: | 1225021587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | PRABHDEEP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2061 ROSS AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EL CENTRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922433687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603525800 | ||||||||
| FaxNumber: | 7605450249 | ||||||||
| Practice Location | |||||||||
| Address1: | 2061 ROSS AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EL CENTRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922433687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603525800 | ||||||||
| FaxNumber: | 7605450249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A56053 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A560530 | 05 | CA | MEDICAID | CC6635 | 01 | CA | RAILROAD GROUP # | OTHER | ZZZ47480Z | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |