Provider Demographics
NPI:1033300611
Name:CUTILLAR, MARIROSE (MD)
Entity Type:Individual
Prefix:
First Name:MARIROSE
Middle Name:
Last Name:CUTILLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N CARSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1215
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-887-7046
Practice Address - Street 1:2527 N CARSON ST
Practice Address - Street 2:SUITE 190
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0147
Practice Address - Country:US
Practice Address - Phone:775-887-5140
Practice Address - Fax:775-884-3618
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9379207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21296Medicare UPIN