Provider Demographics
NPI:1558404582
Name:GUTTIKONDA, JYOTHSNA (MD)
Entity type:Individual
Prefix:
First Name:JYOTHSNA
Middle Name:
Last Name:GUTTIKONDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3433 COVE VIEW BLVD
Mailing Address - Street 2:#2523
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554
Mailing Address - Country:US
Mailing Address - Phone:409-392-4641
Mailing Address - Fax:409-772-5451
Practice Address - Street 1:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Practice Address - Street 2:1901 RED ROCK DRIVE
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-7000
Practice Address - Fax:505-726-6742
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9722207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI21353Medicare UPIN