Provider Demographics
NPI:1386182905
Name:GUTIERREZ, FABIAN NATHANIEL (FNP-C)
Entity type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:NATHANIEL
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 BUENA VISTA ST # 103A
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2411
Mailing Address - Country:US
Mailing Address - Phone:626-531-6538
Mailing Address - Fax:
Practice Address - Street 1:1217 BUENA VISTA ST # 103A
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2411
Practice Address - Country:US
Practice Address - Phone:626-531-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily