Healthcare Provider Details

I. General information

NPI: 1558428144
Provider Name (Legal Business Name): TERESA GUTA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E GRAND AVE
ESCONDIDO CA
92025-4402
US

IV. Provider business mailing address

633 E GRAND AVE
ESCONDIDO CA
92025-4402
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-4737
  • Fax: 760-747-9905
Mailing address:
  • Phone: 760-747-4737
  • Fax: 760-747-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21341
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number21341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: