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NPI Code Detail

MEDICARE: GEOFFREY PUTNAM MA BCBA

MEDICARE: GEOFFREY PUTNAM MA BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1851631428
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEOFFREY PUTNAM MA BCBA
Provider Business Mailing Address
First Line : 13920 CITY CENTER DR STE 290
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5444
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13920 CITY CENTER DR STE 290
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5444
Country : US
Telephone Number : 909-287-3557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2013
Last Update Date : 02/19/2013

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