Healthcare Provider Details

I. General information

NPI: 1699792242
Provider Name (Legal Business Name): GUITO WINGFIELD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/17/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 KRESKY AVE.
CENTRALIA WA
98531
US

IV. Provider business mailing address

1755 KRESKY AVE. BOX #16
CENTRALIA WA
98531
US

V. Phone/Fax

Practice location:
  • Phone: 360-669-0098
  • Fax: 360-669-0121
Mailing address:
  • Phone: 360-736-1961
  • Fax: 360-736-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00048810
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: