Provider Demographics
NPI:1134221583
Name:HUTCHINS, MARY JANE (MD)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 NATIONAL AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2632
Mailing Address - Country:US
Mailing Address - Phone:408-358-8998
Mailing Address - Fax:408-358-8818
Practice Address - Street 1:14911 NATIONAL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2632
Practice Address - Country:US
Practice Address - Phone:408-358-8998
Practice Address - Fax:408-358-8818
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A506340Medicaid
CAF67583Medicare UPIN
CA00A506340Medicaid