Healthcare Provider Details

I. General information

NPI: 1629799317
Provider Name (Legal Business Name): NATASHA PUTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79200 CORPORATE CENTER DR STE 201
LA QUINTA CA
92253-7245
US

IV. Provider business mailing address

185 S STATE COLLEGE BLVD UNIT 5035
BREA CA
92821-5887
US

V. Phone/Fax

Practice location:
  • Phone: 760-327-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: