Provider Demographics
NPI:1861423709
Name:GUTIN, MARC (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:GUTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 E FOOTHILL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1255
Mailing Address - Country:US
Mailing Address - Phone:626-335-8094
Mailing Address - Fax:626-335-1874
Practice Address - Street 1:615 E FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1255
Practice Address - Country:US
Practice Address - Phone:626-335-8094
Practice Address - Fax:626-335-1874
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48699207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486990Medicaid
CAWG48699CMedicare PIN
CA00G486990Medicaid