Provider Demographics
NPI:1770444556
Name:GUTIERREZ, GONZALO JR
Entity type:Individual
Prefix:MR
First Name:GONZALO
Middle Name:
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3819
Mailing Address - Country:US
Mailing Address - Phone:310-973-8184
Mailing Address - Fax:
Practice Address - Street 1:4467 W BROADWAY
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3819
Practice Address - Country:US
Practice Address - Phone:310-973-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty