Provider Demographics
NPI:1790269348
Name:GUTE, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GUTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17185 W BERNARDO DR UNIT 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1536
Mailing Address - Country:US
Mailing Address - Phone:858-776-1867
Mailing Address - Fax:
Practice Address - Street 1:12705 MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2529
Practice Address - Country:US
Practice Address - Phone:858-487-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist