Provider Demographics
NPI:1457506065
Name:KATHRYN GUGGENHEIM MD INC
Entity Type:Organization
Organization Name:KATHRYN GUGGENHEIM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGGENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-218-8189
Mailing Address - Street 1:1011 CASS ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4518
Mailing Address - Country:US
Mailing Address - Phone:831-655-5151
Mailing Address - Fax:831-655-5154
Practice Address - Street 1:1011 CASS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4518
Practice Address - Country:US
Practice Address - Phone:831-655-5151
Practice Address - Fax:831-655-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX288Medicare PIN