Healthcare Provider Details

I. General information

NPI: 1184080855
Provider Name (Legal Business Name): RACQUEL SIMONE GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACQUEL ALLEN MD

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

PO BOX 555191
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3505
  • Fax:
Mailing address:
  • Phone: 760-719-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101262969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: