MEDICARE: THOMAS GUTH CP

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	1744P3200X	Prosthetics Case Management
2	224P00000X	Prosthetist	CP000845	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710158043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS GUTH CP

Provider Business Mailing Address
First Line	:	6147 UNIVERSITY AVENUE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-5720
Country	:	US
Telephone Number	:	619-582-3871
Fax Number	:	619-582-3999

Provider Business Practice Location Address
First Line	:	6147 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-5720
Country	:	US
Telephone Number	:	619-582-3871
Fax Number	:	619-582-3999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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Directions to “ THOMAS GUTH CP” Practice Location

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