Healthcare Provider Details

I. General information

NPI: 1972087021
Provider Name (Legal Business Name): JULIAN ENRIQUE GUTIERREZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17801 INDUSTRIAL FARM RD
BAKERSFIELD CA
93308-9599
US

IV. Provider business mailing address

4215 TEAL ST APT B6
BAKERSFIELD CA
93304-6476
US

V. Phone/Fax

Practice location:
  • Phone: 661-391-3100
  • Fax:
Mailing address:
  • Phone: 562-505-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number692301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: