Provider Demographics
NPI:1538253919
Name:GUTTMANN, J LOUVIDA (CFNP)
Entity type:Individual
Prefix:
First Name:J LOUVIDA
Middle Name:
Last Name:GUTTMANN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:LOUVIDA
Other - Middle Name:
Other - Last Name:GUTTMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:933 BRADBURY DR SE STE 1134
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-0148
Mailing Address - Fax:505-272-2991
Practice Address - Street 1:4808 MCMAHON BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5010
Practice Address - Country:US
Practice Address - Phone:505-272-2900
Practice Address - Fax:505-272-2909
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR14530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000S9715Medicaid
S65737Medicare UPIN
NM000S9715Medicaid