MEDICARE: DR. ELANA PUTTERMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	194859	CA

General Provider Information

NPI Number	:	1093277394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELANA PUTTERMAN MD

Provider Business Mailing Address
First Line	:	3736 ATLANTIC AVE STE 101
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3492
Country	:	US
Telephone Number	:	562-256-9929
Fax Number	:

Provider Business Practice Location Address
First Line	:	3736 ATLANTIC AVE STE 101
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3492
Country	:	US
Telephone Number	:	562-256-9929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	11/06/2024

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