MEDICARE: GUTSON MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	G42200	CA

General Provider Information

NPI Number	:	1457401804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUTSON MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3549 VETERAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3549 VETERAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6111
Country	:	US
Telephone Number	:	310-792-3914
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRENE GUTSON
Credential	:
Telephone Number	:	310-792-3914

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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