Healthcare Provider Details

I. General information

NPI: 1366119596
Provider Name (Legal Business Name): ADYLIA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E RIO SALADO PKWY
TEMPE AZ
85281-0241
US

IV. Provider business mailing address

260 E RIO SALADO PKWY APT 3003
TEMPE AZ
85281-0243
US

V. Phone/Fax

Practice location:
  • Phone: 310-467-6909
  • Fax:
Mailing address:
  • Phone: 424-335-5194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: