Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A83674 | CA |
N | 207YS0123X | Facial Plastic Surgeon | A83674 | CA |
NPI | 1063584092 |
---|---|
Provider Name | Michelle Ann Putnam |
First Address | Culver City, CA 90232-6839 |
Second Address | Culver City, CA 90232-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 06/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I01800 | (02) | CA |