Provider Demographics
NPI:1073517009
Name:JEFFREY J. GUTTAS. MD, INC.
Entity Type:Organization
Organization Name:JEFFREY J. GUTTAS. MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-696-4101
Mailing Address - Street 1:100 S SAN MATEO DR
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3805
Mailing Address - Country:US
Mailing Address - Phone:650-696-4101
Mailing Address - Fax:650-696-4121
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:STE 400
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:650-696-4101
Practice Address - Fax:650-696-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG612560207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G612560Medicaid
CA0716704OtherAETNA
CA0732307OtherAETNA
ZZZ52816ZOtherBS
CA00G612561Medicaid
CA0718408OtherAETNA
F25350Medicare UPIN
CA00G612561Medicaid
CA0718408OtherAETNA
ZZZ13410ZMedicare ID - Type Unspecified