Provider Demographics
NPI:1043362544
Name:MARC GUTIN M D INC
Entity type:Organization
Organization Name:MARC GUTIN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-335-8094
Mailing Address - Street 1:615 E FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1255
Mailing Address - Country:US
Mailing Address - Phone:626-335-8094
Mailing Address - Fax:
Practice Address - Street 1:615 E FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1255
Practice Address - Country:US
Practice Address - Phone:626-335-8094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48699207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486990Medicaid
CA00G486990Medicaid
CAW19713Medicare PIN