Healthcare Provider Details

I. General information

NPI: 1922120971
Provider Name (Legal Business Name): PUTT C PETRULLI DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N GARFIELD AVE STE 6
ALHAMBRA CA
91801-2400
US

IV. Provider business mailing address

330 N GARFIELD AVE STE 6
ALHAMBRA CA
91801-2400
US

V. Phone/Fax

Practice location:
  • Phone: 626-282-9950
  • Fax:
Mailing address:
  • Phone: 626-282-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2492
License Number StateCA

VIII. Authorized Official

Name: PUTT C PETRULLI
Title or Position: OWNER
Credential: DPM
Phone: 626-282-9950