Healthcare Provider Details

I. General information

NPI: 1326314576
Provider Name (Legal Business Name): ROLANDO GUTIERREZ M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 03/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 W VICTORY BLVD
BURBANK CA
91505-1334
US

IV. Provider business mailing address

4314 W VICTORY BLVD
BURBANK CA
91505-1334
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-6611
  • Fax: 818-843-6656
Mailing address:
  • Phone: 818-843-6611
  • Fax: 818-843-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA93879
License Number StateCA

VIII. Authorized Official

Name: DR. ROLANDO GUTIERREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-664-2073