Healthcare Provider Details

I. General information

NPI: 1831018787
Provider Name (Legal Business Name): DEVON GUTEKUNST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 SEPULVEDA BLVD
CULVER CITY CA
90230-4605
US

IV. Provider business mailing address

322 CULVER BLVD # 1008
PLAYA DEL REY CA
90293-7704
US

V. Phone/Fax

Practice location:
  • Phone: 310-450-4773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number960000185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: