Provider Demographics
NPI:1972911097
Name:PRENDIVILLE PROPERTIES, INC.
Entity Type:Organization
Organization Name:PRENDIVILLE PROPERTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PRENDIVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-547-3228
Mailing Address - Street 1:11 COBALT DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-5906
Mailing Address - Country:US
Mailing Address - Phone:949-547-3228
Mailing Address - Fax:
Practice Address - Street 1:11 COBALT DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-5906
Practice Address - Country:US
Practice Address - Phone:949-547-3228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty