Healthcare Provider Details

I. General information

NPI: 1780684910
Provider Name (Legal Business Name): DAVID GUTIERREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17095 MAIN ST
HESPERIA CA
92345-6004
US

IV. Provider business mailing address

17095 MAIN ST
HESPERIA CA
92345-6004
US

V. Phone/Fax

Practice location:
  • Phone: 760-948-6606
  • Fax: 760-951-1609
Mailing address:
  • Phone: 760-948-6606
  • Fax: 760-951-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA50633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: