Provider Demographics
NPI:1952000929
Name:PUTRUS, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:PUTRUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10981 SAN DIEGO MISSION RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2448
Mailing Address - Country:US
Mailing Address - Phone:619-521-9569
Mailing Address - Fax:619-521-0867
Practice Address - Street 1:10981 SAN DIEGO MISSION RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2448
Practice Address - Country:US
Practice Address - Phone:619-521-9569
Practice Address - Fax:619-521-0867
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist