Provider Demographics
NPI:1124420773
Name:GUTIERREZ, ISAURA (VN)
Entity type:Individual
Prefix:
First Name:ISAURA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:VN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6724
Mailing Address - Country:US
Mailing Address - Phone:323-357-8580
Mailing Address - Fax:
Practice Address - Street 1:10506 OTIS ST
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6724
Practice Address - Country:US
Practice Address - Phone:323-357-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243596164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse