Healthcare Provider Details

I. General information

NPI: 1295086262
Provider Name (Legal Business Name): ZHIKE PRUETT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2012
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FOURTH AVE SUITE 220
SAN DIEGO CA
92103-2116
US

IV. Provider business mailing address

9610 GRANITE RIDGE DR SUITE B
SAN DIEGO CA
92123-2684
US

V. Phone/Fax

Practice location:
  • Phone: 866-284-2771
  • Fax: 619-297-8379
Mailing address:
  • Phone: 866-284-2771
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: