Basic Information
| Provider Information | |||||||||
| NPI: | 1083726921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUTILA | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | ARMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 874 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955401926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077253334 | ||||||||
| FaxNumber: | 7077252455 | ||||||||
| Practice Location | |||||||||
| Address1: | 874 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FORTUNA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955401926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077253334 | ||||||||
| FaxNumber: | 7077252455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A020189 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A20189 | 05 | CA | MEDICAID |