Healthcare Provider Details

I. General information

NPI: 1548983414
Provider Name (Legal Business Name): AURA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 223RD ST APT 212
CARSON CA
90745-3672
US

IV. Provider business mailing address

400 W 223RD ST APT 212
CARSON CA
90745-3672
US

V. Phone/Fax

Practice location:
  • Phone: 562-347-7102
  • Fax:
Mailing address:
  • Phone: 562-347-7102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: