Provider Demographics
NPI:1417797960
Name:GUTIERREZ, JAMMY ALEXANDRA
Entity type:Individual
Prefix:
First Name:JAMMY
Middle Name:ALEXANDRA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3266 LITTLE MOUNTAIN DR APT C
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-0909
Mailing Address - Country:US
Mailing Address - Phone:909-562-8666
Mailing Address - Fax:
Practice Address - Street 1:1535 S D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3253
Practice Address - Country:US
Practice Address - Phone:909-884-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker