Healthcare Provider Details

I. General information

NPI: 1679487771
Provider Name (Legal Business Name): EMILY GRACIELA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15954 CHIWI RD
APPLE VALLEY CA
92307-7838
US

IV. Provider business mailing address

7524 PISMO AVE
HESPERIA CA
92345-7426
US

V. Phone/Fax

Practice location:
  • Phone: 833-227-3454
  • Fax:
Mailing address:
  • Phone: 442-646-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: