Provider Demographics
NPI:1083760607
Name:PUTNAM, ANGELICA ROCIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:ROCIO
Last Name:PUTNAM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:100 N MEDICAL DR
Mailing Address - Street 2:PRIMAY CHILDREN'S MEDICAL CENTER DEPT OF PATHOLOGY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-662-2150
Mailing Address - Fax:801-662-2165
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:PRIMAY CHILDREN'S MEDICAL CENTER DEPT OF PATHOLOGY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-2150
Practice Address - Fax:801-662-2165
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-12-01
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Provider Licenses
StateLicense IDTaxonomies
UT5413955-1205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology