Provider Demographics
NPI:1295262541
Name:YENKOSKY, PRANA LUISA (MMS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:PRANA
Middle Name:LUISA
Last Name:YENKOSKY
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:PRANA
Other - Middle Name:LUISA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 GREEN RIVER RD STE 105-315
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7433
Mailing Address - Country:US
Mailing Address - Phone:818-378-7144
Mailing Address - Fax:
Practice Address - Street 1:751 S WEIR CANYON RD STE 165
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1962
Practice Address - Country:US
Practice Address - Phone:714-831-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54370363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical