Healthcare Provider Details

I. General information

NPI: 1407983026
Provider Name (Legal Business Name): MICHELE ANN PUTINI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 W FOOTHILL BLVD STE 11
UPLAND CA
91786-3577
US

IV. Provider business mailing address

2335 W FOOTHILL BLVD STE 11
UPLAND CA
91786-3577
US

V. Phone/Fax

Practice location:
  • Phone: 909-618-0257
  • Fax:
Mailing address:
  • Phone: 909-618-0257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: