MEDICARE: THANKAMMA JOHN PUTHIAPARAMPIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A36048	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A36048	OTHER	CA	MEDICAL LICENSE#

General Provider Information

NPI Number	:	1114964525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANKAMMA JOHN PUTHIAPARAMPIL M.D.

Provider Business Mailing Address
First Line	:	1400 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

Provider Business Practice Location Address
First Line	:	1400 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/07/2023

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