Provider Demographics
NPI:1609003953
Name:STOLTZ-PRUITT, ANNE ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELIZABETH
Last Name:STOLTZ-PRUITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 RENDOVA RD RM 16
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5490
Mailing Address - Country:US
Mailing Address - Phone:619-437-2860
Mailing Address - Fax:
Practice Address - Street 1:2841 RENDOVA RD RM 16
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5490
Practice Address - Country:US
Practice Address - Phone:619-437-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003765A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine