Healthcare Provider Details

I. General information

NPI: 1639021413
Provider Name (Legal Business Name): ELIZABETH GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37720 FREMONT BLVD
FREMONT CA
94536-5025
US

IV. Provider business mailing address

37720 FREMONT BLVD
FREMONT CA
94536-5025
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-2072
  • Fax:
Mailing address:
  • Phone: 510-797-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number254203B4A9
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: