Basic Information
| Provider Information | |||||||||
| NPI: | 1538253919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTTMANN | ||||||||
| FirstName: | J LOUVIDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CFNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GUTTMANN | ||||||||
| OtherFirstName: | LOUVIDA | ||||||||
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| OtherCredential: | CNP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 933 BRADBURY DR SE STE 1134 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052720148 | ||||||||
| FaxNumber: | 5052722991 | ||||||||
| Practice Location | |||||||||
| Address1: | 4808 MCMAHON BLVD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871145010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722900 | ||||||||
| FaxNumber: | 5052722909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R14530 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000S9715 | 05 | NM | MEDICAID |