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 1:210 S GRAND AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4205
Mailing Address - Country:US
Mailing Address - Phone:626-335-8094
Mailing Address - Fax:
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4205
Practice Address - Country:US
Practice Address - Phone:626-335-8094
Practice Address - Fax:626-335-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-07-24
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