Healthcare Provider Details

I. General information

NPI: 1083624795
Provider Name (Legal Business Name): MARIO SKILES GUTIERREZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 EL CAMINO REAL STE I
BELMONT CA
94002-2006
US

IV. Provider business mailing address

390 EL CAMINO REAL STE I
BELMONT CA
94002-2006
US

V. Phone/Fax

Practice location:
  • Phone: 650-591-9674
  • Fax: 650-591-0250
Mailing address:
  • Phone: 650-279-1516
  • Fax: 650-279-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: