Healthcare Provider Details

I. General information

NPI: 1780661512
Provider Name (Legal Business Name): SHARON L PUITA RN ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 PHILLIPS LN 203
SAN LUIS OBISPO CA
93401-2537
US

IV. Provider business mailing address

1428 PHILLIPS LN 203
SAN LUIS OBISPO CA
93401-2537
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-4407
  • Fax: 805-543-4587
Mailing address:
  • Phone: 805-543-4407
  • Fax: 805-543-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number456921
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: