Holly Diahn Prentice, P.A.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

15115 Issued in CA

Practice address

440 W Foothill Blvd
Glendora, CA 91741-3361

Phone

(626) 963-9402

Fax

(626) 914-5316

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Next Step Medical Inc.

  • Urgent Care Clinic/Center
  • Oceanside, CA
  • NPI 1164730404
  Medicare reassignment NPD
• Marque Medical Clinic, Inc.

  • Urgent Care Clinic/Center
  • Newport Beach, CA
  • NPI 1538466107
  Medicare reassignment
• Minghsun Liu, M.D., PC

  • Infectious Disease Physician
  • Los Angeles, CA
  • NPI 1518309368
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588606404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W FOOTHILL BLVD",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917413361",
            "telephone_number": "626-963-9402",
            "fax_number": "626-914-5316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W FOOTHILL BLVD",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917413361",
            "telephone_number": "626-963-9402",
            "fax_number": "626-914-5316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "HOLLY",
        "middle_name": "DIAHN",
        "name_prefix": "Mrs.",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "15115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Polaris Specialty Pharmacy, LLC
• Jeffrey Joseph Pomerance, M.D.
• Kristen Powell
• Paula Virginia Preciado Romero
• Kelly Marie Preite, MPT
• Taylor Presco, SLP
• Prestige Inhome Care, Inc.
• Hannah M Price, BA
• Parkar Corinne Price, PT, DPT
• Prime Choice Home Health

• Medical Physician Assistant in Glendora, CA
• Providers in Glendora, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.