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General NPI Number Information
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NPI Number | 1043362544
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Entity Type | Organization
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Legal Business Name | MARC GUTIN M D INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 615 E FOOTHILL BLVD STE C
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City | SAN DIMAS
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State | CA
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Zip | 91773-1255
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Country | US
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Telephone | 626-335-8094
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Fax |
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Provider Business Mailing Address
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Address Line | 615 E FOOTHILL BLVD STE C
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City | SAN DIMAS
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State | CA
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Zip | 91773-1255
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Country | US
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Telephone | 626-335-8094
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC S GUTIN
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Credential | M.D.
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Telephone | 626-335-8094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G48699
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License Number State | CA
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