Provider Demographics
NPI:1427725639
Name:GUTIERREZ, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
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 1:433 S SAN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3234
Mailing Address - Country:US
Mailing Address - Phone:909-451-1784
Mailing Address - Fax:
Practice Address - Street 1:5369 INGLEWOOD BLVD BLDG APT 3
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5956
Practice Address - Country:US
Practice Address - Phone:833-831-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-09-04
Deactivation Date:2024-06-03
Deactivation Code:
Reactivation Date:2024-09-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst