Basic Information
| Provider Information | |||||||||
| NPI: | 1265440077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRESCOTT | ||||||||
| FirstName: | DEANA | ||||||||
| MiddleName: | JUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 E HUISACHE ST | ||||||||
| Address2: | APT. B | ||||||||
| City: | SOUTH PADRE ISLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785977117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565345588 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4314 YOAKUM BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770065818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138500049 | ||||||||
| FaxNumber: | 7136277302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G8351 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | TX | MEDICAID |