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NPI Code Detail

MEDICARE: DARLENE GUTIERREZ

MEDICARE: DARLENE GUTIERREZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor6625CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17086OTHERCAPROVIDER NUMBER

General Provider Information

NPI Number : 1063632230
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARLENE GUTIERREZ
Provider Business Mailing Address
First Line : PO BOX 452
Second Line :
City : CANOGA PARK
State : CA
Zip : 91305-0452
Country : US
Telephone Number : 818-664-5511
Fax Number :
Provider Business Practice Location Address
First Line : 909 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1326
Country : US
Telephone Number : 310-314-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2007
Last Update Date : 07/09/2024

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Directions to “ DARLENE GUTIERREZ ” Practice Location

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