Provider Demographics
NPI:1245102441
Name:GUTIERREZ, EVANGELINA (BEHAVIORIST)
Entity type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:BEHAVIORIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17134 CORONADO AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1595
Mailing Address - Country:US
Mailing Address - Phone:909-582-6293
Mailing Address - Fax:
Practice Address - Street 1:10261 TRADEMARK STREET
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-481-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician