Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | A135583 | CA |
NPI | 1194169953 |
---|---|
Provider Name | Dr. Laura Nicole Pruitt |
First Address | Los Angeles, CA 90010-2814 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 27/07/2018 |