Individual
MR. AVINESH PRAKASH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2315 STOCKTON BLVD, SACRAMENTO, CA 95817-2201
(916) 734-8556
Mailing address
1441 FLORIDA AVE, MODESTO, CA 95350-4404
(209) 576-3525
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95014139
CA
Other
Enumeration date
03/10/2020
Last updated
07/29/2021
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