Provider Demographics
NPI:1346937059
Name:COLINA PRATTS, CELYNESS
Entity type:Individual
Prefix:
First Name:CELYNESS
Middle Name:
Last Name:COLINA PRATTS
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 1:2501 W BURBANK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2347
Mailing Address - Country:US
Mailing Address - Phone:818-856-9535
Mailing Address - Fax:
Practice Address - Street 1:2177 W BURLWOOD WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-7038
Practice Address - Country:US
Practice Address - Phone:787-638-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10211363AM0700X
PRPA-1410363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical