Individual
THAVARAT PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5825 E CAMINO MANZANO, ANAHEIM, CA 92807-3254
(714) 396-7421
Mailing address
5825 E CAMINO MANZANO, ANAHEIM, CA 92807-3254
(714) 396-7421
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN499241
CA
Other
Enumeration date
03/30/2007
Last updated
05/06/2009
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