Provider Demographics
NPI:1346474921
Name:PUTZIGER, IVAN RODRIGO KIRYLUK (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:RODRIGO KIRYLUK
Last Name:PUTZIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IVAN
Other - Middle Name:KIRYLUK
Other - Last Name:PUTZIGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 CALIFORNIA DR.
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-448-6841
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DR.
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-448-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1256122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program