Healthcare Provider Details

I. General information

NPI: 1073517009
Provider Name (Legal Business Name): JEFFREY J. GUTTAS. MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S SAN MATEO DR STE 400
SAN MATEO CA
94401-3805
US

IV. Provider business mailing address

100 S SAN MATEO DR STE 400
SAN MATEO CA
94401-3805
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-4101
  • Fax: 650-696-4121
Mailing address:
  • Phone: 650-696-4101
  • Fax: 650-696-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG612560
License Number StateCA

VIII. Authorized Official

Name: MRS. JANICE NG
Title or Position: BILLING MANAGER
Credential:
Phone: 650-696-4101