Doctor Name: | DR. AJITHKUMAR A PUTHILLATH |
NPI Number: | 1225275233 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | A107213 |
Business Practice Address: | 2626 N California St Suite B Stockton, CA - 952045500 |
Business Phone Number: | 2094662626 |
Business Fax Number: | 2064662199 |
Mailing Address: | 2626 N California St, Suite B STOCKTON |
State: | CA |
Postal Code: | 952045500 |
Phone Number: | 2094662626 |
Fax Number: | 2094662199 |
NPI Enumeration Date: | 01/13/2009 |
NPI Last Update Date: | 07/31/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | A107213 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |