Provider Demographics
NPI:1639700727
Name:CHRISTOPHER V LUTMAN MD A CALIFORNIA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTOPHER V LUTMAN MD A CALIFORNIA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:V
Authorized Official - Last Name:LUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-315-7976
Mailing Address - Street 1:1130 E CLARK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 JAMES WAY STE 109
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-4974
Practice Address - Country:US
Practice Address - Phone:805-416-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB342708OtherMEDICARE GROUP