Healthcare Provider Details

I. General information

NPI: 1326562638
Provider Name (Legal Business Name): GERARDO GUTIERREZ MARTINEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 E. IMPERIAL HWY
DOWNEY CA
90242
US

IV. Provider business mailing address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: