Provider Demographics
NPI:1992134001
Name:GUTIERREZ, SUSANA
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:GUTIERREZ
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 1:3607 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4390
Mailing Address - Country:US
Mailing Address - Phone:510-491-3158
Mailing Address - Fax:510-580-7805
Practice Address - Street 1:3607 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4390
Practice Address - Country:US
Practice Address - Phone:510-491-3158
Practice Address - Fax:510-580-7805
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker