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Individual

CARYL PRUNTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1401 DEL MAR AVE, MODESTO, CA 95350-4805
(209) 476-8533
Mailing address
1212 N. CALIFORNIA ST., STOCKTON, CA 95202
(209) 476-8533

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary

Other

Enumeration date
03/02/2015
Last updated
03/02/2015
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  • Eligibility checks
  • EDI platform