Healthcare Provider Details

I. General information

NPI: 1679677967
Provider Name (Legal Business Name): ALEX KUTAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST 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 NumberG30388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: