Provider Demographics
NPI:1972953685
Name:GUTIERREZ, WESTON JOSEPH I
Entity type:Individual
Prefix:MR
First Name:WESTON
Middle Name:JOSEPH
Last Name:GUTIERREZ
Suffix:I
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 1:141 ANN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-3103
Mailing Address - Country:US
Mailing Address - Phone:661-992-4005
Mailing Address - Fax:
Practice Address - Street 1:141 ANN AVE
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-3103
Practice Address - Country:US
Practice Address - Phone:661-992-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4478446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health