Provider Demographics
NPI:1225597073
Name:PUTZ, CODY WHITLEY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:WHITLEY
Last Name:PUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1346
Mailing Address - Country:US
Mailing Address - Phone:650-255-1284
Mailing Address - Fax:
Practice Address - Street 1:957 INDUSTRIAL RD STE B
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4152
Practice Address - Country:US
Practice Address - Phone:650-620-9549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker