Provider Demographics
NPI:1053505982
Name:UTZURRUM, FRANKIE D (MD)
Entity type:Individual
Prefix:DR
First Name:FRANKIE
Middle Name:D
Last Name:UTZURRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:D
Other - Last Name:UTZURRUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:99 N SAN ANTONIO AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4579
Mailing Address - Country:US
Mailing Address - Phone:909-946-6342
Mailing Address - Fax:
Practice Address - Street 1:99 N SAN ANTONIO AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4579
Practice Address - Country:US
Practice Address - Phone:909-946-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31438207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314380Medicaid
CA00A314380Medicaid