Provider Demographics
NPI:1912026642
Name:GUTIERREZ, SALOME R (PHD)
Entity type:Individual
Prefix:DR
First Name:SALOME
Middle Name:R
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:79301 COUNTRY CLUB DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1250
Mailing Address - Country:US
Mailing Address - Phone:760-333-8393
Mailing Address - Fax:760-347-2904
Practice Address - Street 1:79301 COUNTRY CLUB DR STE 102
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-1250
Practice Address - Country:US
Practice Address - Phone:760-333-8393
Practice Address - Fax:760-347-2904
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31929103T00000X
CA1-18-31459103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst