Healthcare Provider Details

I. General information

NPI: 1942277074
Provider Name (Legal Business Name): JOHN S. GUTIA IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 821 BOX 22
RUISLIP MIDDLESEX
FPO AE 09421
GB

IV. Provider business mailing address

PSC 821 BOX 22
RUISLIP MIDDLESEX
FPO AE 09421
GB

V. Phone/Fax

Practice location:
  • Phone: 01638526339
  • Fax: 01638526323
Mailing address:
  • Phone: 01638526339
  • Fax: 01638526323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: