Healthcare Provider Details

I. General information

NPI: 1386783942
Provider Name (Legal Business Name): LISA JOY KUTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE. B225
LA JOLLA CA
92037-1714
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE. B225
LA JOLLA CA
92037-1714
US

V. Phone/Fax

Practice location:
  • Phone: 619-688-1855
  • Fax:
Mailing address:
  • Phone: 619-688-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG85706
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG85706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: