MEDICARE: MS. LETICIA MARIA GUTIERREZ MS, LMFT

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
1	106H00000X	Marriage & Family Therapist	111858	CA

General Provider Information

NPI Number	:	1376001883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETICIA MARIA GUTIERREZ MS, LMFT

Provider Business Mailing Address
First Line	:	7104 STATE ST
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5403
Country	:	US
Telephone Number	:	213-910-2551
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 PIER AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5311
Country	:	US
Telephone Number	:	310-880-3825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	07/14/2025

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