Healthcare Provider Details

I. General information

NPI: 1407207525
Provider Name (Legal Business Name): HORIA PUTICI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 600
ENCINO CA
91436-4604
US

IV. Provider business mailing address

16260 VENTURA BLVD STE 600
ENCINO CA
91436-4604
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number0000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: