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General NPI Number Information
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NPI Number | 1124178900
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Entity Type | Individual
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Provider Name | NICHOLAS HERKIMER PUTNAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4401 MANCHESTER AVE SUITE #101
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City | ENCINITAS
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State | CA
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Zip | 92024-4938
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Country | US
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Telephone | 760-753-4564
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Fax | 760-753-1541
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Provider Business Mailing Address
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Address Line | 4401 MANCHESTER AVE SUITE #101
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City | ENCINITAS
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State | CA
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Zip | 92024-4938
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Country | US
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Telephone | 760-753-4564
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Fax | 760-753-1541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G27562
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | G27562
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License Number State | CA
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