MEDICARE: SUSAN E GUTIERREZ MD

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	208VP0000X	Pain Medicine Physician	A86541	CA

General Provider Information

NPI Number	:	1518961127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E GUTIERREZ MD

Provider Business Mailing Address
First Line	:	100 PARK PL
Second Line	:	SUITE 120
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4460
Country	:	US
Telephone Number	:	925-806-0757
Fax Number	:	925-277-1557

Provider Business Practice Location Address
First Line	:	100 PARK PL
Second Line	:	SUITE 120
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4460
Country	:	US
Telephone Number	:	925-806-0757
Fax Number	:	925-277-1557

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/28/2021

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