Provider Demographics
NPI:1710158043
Name:GUTH, THOMAS (CP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GUTH
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5720
Mailing Address - Country:US
Mailing Address - Phone:619-582-3871
Mailing Address - Fax:619-582-3999
Practice Address - Street 1:6147 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5720
Practice Address - Country:US
Practice Address - Phone:619-582-3871
Practice Address - Fax:619-582-3999
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
CACP000845224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0008450Medicaid