Provider Demographics
NPI:1992299457
Name:PRUNA FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:PRUNA FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-598-0270
Mailing Address - Street 1:13140 COIT RD STE 312
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5703
Mailing Address - Country:US
Mailing Address - Phone:972-598-0270
Mailing Address - Fax:
Practice Address - Street 1:13140 COIT RD STE 312
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5703
Practice Address - Country:US
Practice Address - Phone:972-598-0270
Practice Address - Fax:972-598-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7330207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty