Individual
MR. RAJA SEKHAR PRABHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(408) 569-9735
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(408) 569-9735
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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