Alberta Pruitt, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11049 Issued in CA

Practice address

220 S Palisade Dr
Santa Maria, CA 93454-8902

Phone

(805) 681-5461

Fax

(805) 681-5200

NPI assigned

Mar 29, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619096609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N SAN ANTONIO RD",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931101316",
            "telephone_number": "805-681-5461",
            "fax_number": "805-681-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S PALISADE DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934548902",
            "telephone_number": "805-681-5461",
            "fax_number": "805-681-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "ALBERTA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A110490",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA11049",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Jay Prober, PT
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• Jon W Propst, MD
• Sandra Provencio
• Arely Pulido, CPHW
• Victor Ismael Pulido, D.O.
• Annelie S. Purdy, PH.D.
• Purnima Sheoran DDS, Inc (Mai Dental Care)
• Earl W Purper, MFT

• Physician Assistant in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.