Healthcare Provider Details

I. General information

NPI: 1316193873
Provider Name (Legal Business Name): DESIREE MARIE GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W WALNUT PKWY
COMPTON CA
90220-5030
US

IV. Provider business mailing address

18008 S HOBART BLVD
GARDENA CA
90248-3616
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-5379
  • Fax:
Mailing address:
  • Phone: 310-291-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: