Organization
RD PRABHU-LATA K SHETE MDS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHAKONDA DAYANANDA PRABHU MD (PRESIDENT)
(702) 877-9514
Entity
Organization
Contact information
Practice address
5701 W CHARLESTON BLVD, SUITE 100, LAS VEGAS, NV 89146-1217
(702) 877-9514
(702) 877-0399
Mailing address
5701 W CHARLESTON BLVD, SUITE 100, LAS VEGAS, NV 89146-1217
(702) 877-9514
(702) 312-3510
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506357
—
NV
01
—
XGG00737
MEDI-CAL
CA
Enumeration date
10/10/2005
Last updated
08/22/2020
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