Basic Information
| Provider Information | |||||||||
| NPI: | 1457718520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRERNA MONA KHANNA MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80254 JASPER PARK AVE | ||||||||
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| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922010821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146290339 | ||||||||
| FaxNumber: | 2095795637 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 N INDIAN CANYON DR | ||||||||
| Address2: | STE W200 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922624800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146290339 | ||||||||
| FaxNumber: | 2095795637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2016 | ||||||||
| LastUpdateDate: | 01/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | KHANNA | ||||||||
| AuthorizedOfficialFirstName: | PRERNA | ||||||||
| AuthorizedOfficialMiddleName: | MONA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MD | ||||||||
| AuthorizedOfficialTelephone: | 2146290339 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G75180 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.