Healthcare Provider Details

I. General information

NPI: 1164528501
Provider Name (Legal Business Name): LARRY LEE NUTTING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HOWE AVE STE 100
SACRAMENTO CA
95825-4732
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 380
LAGUNA HILLS CA
92653-3628
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-9337
  • Fax: 916-924-8281
Mailing address:
  • Phone: 949-599-2423
  • Fax: 949-599-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG79852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: