Provider Demographics
NPI:1326543984
Name:GUTIERREZ, BLANCA KATARZYNA (MD)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:KATARZYNA
Last Name:GUTIERREZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2227
Mailing Address - Country:US
Mailing Address - Phone:619-297-5437
Mailing Address - Fax:619-243-0722
Practice Address - Street 1:550 WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2227
Practice Address - Country:US
Practice Address - Phone:619-297-5437
Practice Address - Fax:619-243-0722
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1326543984208000000X
IL036156318208000000X
390200000X
CAA196673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program