Provider Demographics
NPI:1710052774
Name:PRESCOTT, DAWNELL J (LPT)
Entity Type:Individual
Prefix:MRS
First Name:DAWNELL
Middle Name:J
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MRS
Other - First Name:DAWNELL
Other - Middle Name:J
Other - Last Name:MERRITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12353 E IMPERIAL
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-484-3385
Mailing Address - Fax:562-484-0269
Practice Address - Street 1:12353 E IMPERIAL
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-484-3385
Practice Address - Fax:562-484-0269
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25905167G00000X
167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1512013461Medicaid
CA1512013461Medicare UPIN