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General NPI Number Information
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NPI Number | 1972911097
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Entity Type | Organization
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Legal Business Name | PRENDIVILLE PROPERTIES, INC.
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 11 COBALT DR
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City | DANA POINT
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State | CA
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Zip | 92629-5906
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Country | US
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Telephone | 949-547-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 11 COBALT DR
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City | DANA POINT
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State | CA
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Zip | 92629-5906
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Country | US
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Telephone | 949-547-3228
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN JOHN PRENDIVILLE
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Credential | M.D.
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Telephone | 949-547-3228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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