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General NPI Number Information
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NPI Number | 1073531802
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Entity Type | Individual
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Provider Name | KENNETH JUTZY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 11234 ANDERSON ST #1617
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City | LOMA LINDA
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State | CA
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Zip | 92354-2804
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Country | US
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Telephone | 909-558-8591
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Fax |
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Provider Business Mailing Address
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Address Line | FILE # 54701
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City | LOS ANGELES
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State | CA
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Zip | 90074-4701
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Country | US
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Telephone | 909-558-3111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G37876
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | G37876
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License Number State | CA
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