Healthcare Provider Details

I. General information

NPI: 1477095149
Provider Name (Legal Business Name): SHEILA MARIE PUATU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 BROOKHURST STREET ATTN: WHOLE LIFE DEPARTMENT
FOUNTAIN VALLEY CA
92708-3720
US

IV. Provider business mailing address

17360 BROOKHURST STREET ATTN: WHOLE LIFE DEPARTMENT
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-3450
  • Fax: 714-689-4327
Mailing address:
  • Phone: 657-241-3450
  • Fax: 714-689-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: