Healthcare Provider Details

I. General information

NPI: 1083541775
Provider Name (Legal Business Name): MEGAN GUTILLA PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 N REESE AVE
FRESNO CA
93722-6111
US

IV. Provider business mailing address

1739 N PICCADILLY LN
CLOVIS CA
93619-5053
US

V. Phone/Fax

Practice location:
  • Phone: 559-451-4520
  • Fax:
Mailing address:
  • Phone: 559-723-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: