Healthcare Provider Details

I. General information

NPI: 1972746527
Provider Name (Legal Business Name): MRS. MARIA GUADALUPE GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 HUGHSON AVE SUITE B
HUGHSON CA
95326
US

IV. Provider business mailing address

PO BOX 264
HUGHSON CA
95326-0264
US

V. Phone/Fax

Practice location:
  • Phone: 209-883-2027
  • Fax: 209-883-2028
Mailing address:
  • Phone: 209-883-2027
  • Fax: 209-883-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: