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General NPI Number Information
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NPI Number | 1871199679
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Entity Type | Individual
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Provider Name | SHERISSE SOFIA PUATU DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 1617 WESTCLIFF DR STE 205
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5526
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Country | US
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Telephone | 949-432-4730
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Fax |
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Provider Business Mailing Address
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Address Line | 8013 CANTERBURY WAY
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City | BUENA PARK
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State | CA
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Zip | 90620-2020
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Country | US
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Telephone | 562-413-6086
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95015137
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License Number State | CA
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