Healthcare Provider Details

I. General information

NPI: 1245840016
Provider Name (Legal Business Name): MISS AMBER GABRIELLA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S ANAHEIM BLVD
ANAHEIM CA
92805-6258
US

IV. Provider business mailing address

7358 COUNTRY CLUB DR
DOWNEY CA
90241-2001
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-7641
  • Fax: 714-689-1381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: