Healthcare Provider Details

I. General information

NPI: 1003742792
Provider Name (Legal Business Name): MATTHEW CASEY GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12405 RUBY RIVER DR
BAKERSFIELD CA
93312-6853
US

IV. Provider business mailing address

12405 RUBY RIVER DR
BAKERSFIELD CA
93312-6853
US

V. Phone/Fax

Practice location:
  • Phone: 661-331-4379
  • Fax:
Mailing address:
  • Phone: 661-331-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95228785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: