Individual
KENNETH JUTZY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11234 ANDERSON ST, #1617, LOMA LINDA, CA 92354-2804
(909) 558-8591
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G37876
CA
207RI0011X
Interventional Cardiology Physician
Primary
G37876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G378760
—
CA
Enumeration date
07/18/2006
Last updated
04/12/2010
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