Provider Demographics
NPI:1083726921
Name:JUTILA, GEORGE ARMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ARMAS
Last Name:JUTILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-1926
Mailing Address - Country:US
Mailing Address - Phone:707-725-3334
Mailing Address - Fax:707-725-2455
Practice Address - Street 1:874 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-1926
Practice Address - Country:US
Practice Address - Phone:707-725-3334
Practice Address - Fax:707-725-2455
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA020189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20189Medicaid
A22060Medicare UPIN
CAA20189Medicare ID - Type Unspecified