MEDICARE: UNNEETHA PHILOMENA PRUITT R.N., N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	RN402000	CA
2	363LW0102X	Women's Health Nurse Practitioner	NP14071	CA

General Provider Information

NPI Number	:	1730294174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNNEETHA PHILOMENA PRUITT R.N., N.P.

Provider Business Mailing Address
First Line	:	PO BOX 2369
Second Line	:
City	:	BORREGO SPRINGS
State	:	CA
Zip	:	92004-2369
Country	:	US
Telephone Number	:	760-767-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	4343 YAQUI PASS RD.
Second Line	:
City	:	BORREGO SPRINGS
State	:	CA
Zip	:	92004-2369
Country	:	US
Telephone Number	:	760-767-5051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	04/16/2014

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