Individual
MR. CLINTON EARL PRESCOTT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
296 COTTAGE AVE, MANTECA, CA 95336-4942
(209) 239-2901
(209) 239-8662
Mailing address
296 COTTAGE AVE, MANTECA, CA 95336-4942
(209) 239-2901
(209) 239-8662
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A25653
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A256532
—
CA
Enumeration date
09/13/2006
Last updated
04/15/2008
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