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Individual

DR. RYAN THOMAS PRUENTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
10666 N TORREY PINES RD, LA JOLLA, CA 92037-1027
(858) 554-2626
Mailing address
10790 RANCHO BERNARDO RD, SAN DIEGO, CA 92127-5705
(858) 554-2626

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
C182365
CA
2085R0202X
Diagnostic Radiology Physician
MD187044
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500742059
OR
Enumeration date
04/01/2012
Last updated
12/29/2022
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