Healthcare Provider Details

I. General information

NPI: 1376599779
Provider Name (Legal Business Name): DAISY MARY KUTTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 SOUTH BLOOMFIELD AVENUE
NORWALK CA
90650
US

IV. Provider business mailing address

1600 9TH STREET ROOM 205 MAILSTOP 2-3
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax: 562-864-4560
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA34972
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: