Healthcare Provider Details

I. General information

NPI: 1063880474
Provider Name (Legal Business Name): DANIEL THOMAS GAUTREAU PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD STE 208
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

10330 PIONEER BLVD STE 215
SANTA FE SPRINGS CA
90670-8277
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0677
  • Fax:
Mailing address:
  • Phone: 562-402-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: