Individual
MRS. GLENNISE DANEEN PRATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
36320 INLAND VALLEY DRIVE, 307, WILDOMAR, CA 92595-9083
(951) 600-0110
(951) 600-1489
Mailing address
36320 INLAND VALLEY DR, 307, WILDOMAR, CA 92595-7512
(951) 600-0110
(951) 600-1489
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA21581
CA
Other
Enumeration date
06/05/2011
Last updated
02/11/2016
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