Provider Demographics
NPI:1144318346
Name:PRATTES, ALEXANDER ARTHUR
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ARTHUR
Last Name:PRATTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27871 MEDICAL CENTER RD
Mailing Address - Street 2:#160
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-364-6004
Mailing Address - Fax:949-364-6454
Practice Address - Street 1:27871 MEDICAL CENTER RD
Practice Address - Street 2:#160
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-6004
Practice Address - Fax:949-364-6454
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26587208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A25897Medicare ID - Type Unspecified
A24627Medicare UPIN