Individual
DR. PRASHANTH PORAYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25845 BARTON RD STE 101, LOMA LINDA, CA 92354
(909) 558-3904
Mailing address
25845 BARTON RD STE 101, LOMA LINDA, CA 92354-5300
(909) 558-3904
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
036-138514
IL
2080P0206X
Pediatric Gastroenterology Physician
Primary
C186822
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138514
—
IL
Enumeration date
05/26/2009
Last updated
05/28/2024
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