Provider Demographics
NPI:1215976840
Name:GUTIERREZ, MELISSA E (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:E
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 S ANAHEIM BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3848
Mailing Address - Country:US
Mailing Address - Phone:714-826-1200
Mailing Address - Fax:714-665-4652
Practice Address - Street 1:100 S ANAHEIM BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3848
Practice Address - Country:US
Practice Address - Phone:714-826-1200
Practice Address - Fax:714-665-4652
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA81438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A8114380Medicaid
CA00A8114380Medicaid