Provider Demographics
NPI:1740360924
Name:GUTNER, KIM A (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:GUTNER
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 1:240 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2717
Mailing Address - Country:US
Mailing Address - Phone:858-792-1233
Mailing Address - Fax:858-791-0609
Practice Address - Street 1:240 9TH ST
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2717
Practice Address - Country:US
Practice Address - Phone:858-792-1233
Practice Address - Fax:858-791-0609
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG590832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry