Healthcare Provider Details

I. General information

NPI: 1952000929
Provider Name (Legal Business Name): TANIA PUTRUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 EUCLID AVE STE 225
SAN DIEGO CA
92114-3629
US

IV. Provider business mailing address

292 EUCLID AVE STE 225
SAN DIEGO CA
92114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-9569
  • Fax: 619-521-0867
Mailing address:
  • Phone: 619-521-9569
  • Fax: 619-521-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: