Healthcare Provider Details

I. General information

NPI: 1356609101
Provider Name (Legal Business Name): JENNIFER A GUTILLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

IV. Provider business mailing address

8881 FLETCHER PKWY
LA MESA CA
91942-3134
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5200
  • Fax:
Mailing address:
  • Phone: 619-464-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number38914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: