Individual
DR. PRASHANTH GOWDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
VA LOMA LINDA HEALTH CARE SYSTEM, 11201 BENTON ST, LOMA LINDA, CA 92357-0001
(909) 825-7084
Mailing address
PO BOX 10069, SAN BERNARDINO, CA 92423-0069
(909) 335-4188
(909) 478-3644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036113148
IL
207R00000X
Internal Medicine Physician
036113148
IL
208M00000X
Hospitalist Physician
Primary
C55692
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113148
—
IL
Enumeration date
02/21/2006
Last updated
09/16/2015
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