Provider Demographics
NPI:1558984351
Name:GUTIERREZ DUARTE, LAURA FABIOLA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:FABIOLA
Last Name:GUTIERREZ DUARTE
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 1:6255 W TROPICANA AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4638
Mailing Address - Country:US
Mailing Address - Phone:530-554-7526
Mailing Address - Fax:
Practice Address - Street 1:2360 W HORIZON RIDGE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5082
Practice Address - Country:US
Practice Address - Phone:702-294-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124041106H00000X
NV4758-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist