Provider Demographics
NPI:1194333047
Name:PRENDEZ, LANAE IRENE
Entity type:Individual
Prefix:
First Name:LANAE
Middle Name:IRENE
Last Name:PRENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 HOLLIS ST STE X
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2008
Mailing Address - Country:US
Mailing Address - Phone:510-500-5124
Mailing Address - Fax:510-380-6122
Practice Address - Street 1:5900 HOLLIS ST STE X
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2008
Practice Address - Country:US
Practice Address - Phone:510-500-5124
Practice Address - Fax:510-380-6122
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician