Individual
ANNE MARIE PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1247 E ALLUVIAL AVE STE 101, FRESNO, CA 93720-2686
(559) 431-6226
(559) 440-9005
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A60257
CA
2086S0129X
Vascular Surgery Physician
Primary
A60257
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A602570
MEDI-CAL
CA
01
—
020045926
RAILROAD MEDICARE
CA
Enumeration date
01/26/2006
Last updated
11/06/2019
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