Healthcare Provider Details

I. General information

NPI: 1508960212
Provider Name (Legal Business Name): ENDOCRINOLOGY & DIABETES SPECIALTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH STREET SUITE 103
LONG BEACH CA
90805
US

IV. Provider business mailing address

3300 E SOUTH ST SUITE 103
LAKEWOOD CA
90805-4549
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-9803
  • Fax: 562-634-9845
Mailing address:
  • Phone: 562-634-9803
  • Fax: 562-634-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ALEX KUTAS
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 562-634-9803