Healthcare Provider Details

I. General information

NPI: 1396832879
Provider Name (Legal Business Name): JUAN JOSE GUTIERREZ BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21910 ARLINE AVE
HAWAIIAN GARDENS CA
90716-1211
US

IV. Provider business mailing address

21910 ARLINE AVE
HAWAIIAN GARDENS CA
90716-1211
US

V. Phone/Fax

Practice location:
  • Phone: 562-310-5035
  • Fax:
Mailing address:
  • Phone: 562-310-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: