Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 20A11606 | CA |
NPI | 1164650669 |
---|---|
Provider Name | Christina Prendergast |
First Address | Newport Beach, CA 92660-7704 |
Second Address | Newport Beach, CA 92660-7704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 14/08/2017 |