Provider Demographics
NPI:1568257160
Name:UTLEY, DESTINEE LYNNE
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:LYNNE
Last Name:UTLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S AMPHLETT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2711
Mailing Address - Country:US
Mailing Address - Phone:408-313-0633
Mailing Address - Fax:
Practice Address - Street 1:1700 S AMPHLETT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2711
Practice Address - Country:US
Practice Address - Phone:408-313-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist