Provider Demographics
NPI:1093562472
Name:PRANYS, JOHN M
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:PRANYS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 SARAGLEN DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3224
Mailing Address - Country:US
Mailing Address - Phone:415-601-6643
Mailing Address - Fax:
Practice Address - Street 1:12331 SARAGLEN DR
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-3224
Practice Address - Country:US
Practice Address - Phone:415-601-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CAMPSS-XMQGVK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker