Provider Demographics
NPI:1134293962
Name:CUTTIC, MARIANNE M (DPM)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:M
Last Name:CUTTIC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1970 S PROSPECT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6005
Mailing Address - Country:US
Mailing Address - Phone:310-316-7020
Mailing Address - Fax:310-316-7411
Practice Address - Street 1:1970 S PROSPECT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6005
Practice Address - Country:US
Practice Address - Phone:310-316-7020
Practice Address - Fax:310-316-7411
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3959213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03959OtherSTATE LIC
CA03959OtherSTATE LIC