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Individual
ALBERTA PRUITT
Active
Individual
ALBERTA PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA11049
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A110490
—
CA
01
—
PA11049
PA LICENSE
CA
Enumeration date
03/29/2007
Last updated
07/08/2007
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