Healthcare Provider Details

I. General information

NPI: 1992340897
Provider Name (Legal Business Name): OLIVIA RIVERA-GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W CARLA VISTA DR
CHANDLER AZ
85224-4350
US

IV. Provider business mailing address

1209 W CARLA VISTA DR
CHANDLER AZ
85224-4350
US

V. Phone/Fax

Practice location:
  • Phone: 480-433-0409
  • Fax:
Mailing address:
  • Phone: 480-433-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATR-009303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: