Provider Demographics
NPI:1306163985
Name:GUTTERMAN, JANE CAROL
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:CAROL
Last Name:GUTTERMAN
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 1:22615 SW 66TH AVE
Mailing Address - Street 2:# 105
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5318
Mailing Address - Country:US
Mailing Address - Phone:561-852-6716
Mailing Address - Fax:561-483-3949
Practice Address - Street 1:22615 SW 66TH AVE
Practice Address - Street 2:# 105
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5318
Practice Address - Country:US
Practice Address - Phone:561-852-6716
Practice Address - Fax:561-483-3949
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist