Provider Demographics
NPI:1427665215
Name:GUTIERREZ, DENISE ANGELA
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANGELA
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 1:20208 NESTOR AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3128
Mailing Address - Country:US
Mailing Address - Phone:424-535-9037
Mailing Address - Fax:
Practice Address - Street 1:20208 NESTOR AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3128
Practice Address - Country:US
Practice Address - Phone:424-535-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician