Provider Demographics
NPI:1689761033
Name:MUTIA, JOSE P (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:P
Last Name:MUTIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:21700 GOLDEN TRIANGLE RD
Mailing Address - Street 2:#206
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350
Mailing Address - Country:US
Mailing Address - Phone:661-287-3983
Mailing Address - Fax:661-287-0182
Practice Address - Street 1:21700 GOLDEN TRIANGLE RD
Practice Address - Street 2:#206
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350
Practice Address - Country:US
Practice Address - Phone:661-287-3983
Practice Address - Fax:661-287-0182
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA38795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28726Medicare UPIN