Healthcare Provider Details

I. General information

NPI: 1023647054
Provider Name (Legal Business Name): ADRIANA GUTIERREZ PELAYO SUDRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE # RSYDP
FRESNO CA
93705-4206
US

IV. Provider business mailing address

2550 W CLINTON AVE UNIT 311
FRESNO CA
93705-4218
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-1548
  • Fax:
Mailing address:
  • Phone: 559-213-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: