Individual
MISS PRACHI P VISHWASRAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 550-3984
(209) 550-4872
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01079116
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A137379
CA
207RP1001X
Pulmonary Disease Physician
A137379
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2011
Last updated
10/09/2020
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