Healthcare Provider Details

I. General information

NPI: 1770580375
Provider Name (Legal Business Name): ASIT PRUTHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ABBOTT ST
SALINAS CA
93901-4315
US

IV. Provider business mailing address

63 S ROCKFORD DR STE 220
TEMPE AZ
85288-6226
US

V. Phone/Fax

Practice location:
  • Phone: 831-771-3900
  • Fax: 831-771-3966
Mailing address:
  • Phone: 831-771-3900
  • Fax: 831-771-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA53056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: