| Provider / Organization | NPI | Date Certified |
|---|---|---|
| DEEOZJA PRUITT | 1982208831 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Deeozja Pruitt |
| Practice Office Address | 3757 WESTMONT DR APT 12 CINCINNATI, OH US |
| Practice Office Telephone | 5132912702 |
| Mailing Address | 3757 WESTMONT DR APT 12 CINCINNATI, OH 452051240 US |
| Business Telephone | 5132912702 |
| Code | License No | State |
|---|---|---|
| 374U00000X PRIMARY |