Provider Demographics
NPI:1942277074
Name:GUTIA, JOHN S (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:GUTIA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 821
Mailing Address - Street 2:BOX 22
Mailing Address - City:RUISLIP
Mailing Address - State:MIDDLESEX
Mailing Address - Zip Code:FPO AE 09421
Mailing Address - Country:GB
Mailing Address - Phone:0163-852-6339
Mailing Address - Fax:0163-852-6323
Practice Address - Street 1:PSC 821
Practice Address - Street 2:BOX 22
Practice Address - City:RUISLIP
Practice Address - State:MIDDLESEX
Practice Address - Zip Code:FPO AE 09421
Practice Address - Country:GB
Practice Address - Phone:0163-852-6339
Practice Address - Fax:0163-852-6323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman