Healthcare Provider Details

I. General information

NPI: 1659040947
Provider Name (Legal Business Name): DAISY GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3989 W STETSON AVE STE 105
HEMET CA
92545-9697
US

IV. Provider business mailing address

24630 WASHINGTON AVE STE 201
MURRIETA CA
92562-6177
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-3334
  • Fax:
Mailing address:
  • Phone: 951-200-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: