Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A122156 | CA |
Y | 2080P0202X | Pediatric Cardiologist | A122156 | CA |
NPI | 1184917353 |
---|---|
Provider Name | Dr. Gregory James Jutzy |
First Address | Loma Linda, CA 92354-2804 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2011 |
Last Update Date | 29/01/2020 |