Healthcare Provider Details

I. General information

NPI: 1164383337
Provider Name (Legal Business Name): ALEXANDRA GUTIERREZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 S GREVILLEA AVE
INGLEWOOD CA
90301-3312
US

IV. Provider business mailing address

8019 WHITMORE ST
ROSEMEAD CA
91770-2440
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-4354
  • Fax:
Mailing address:
  • Phone: 323-893-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA65574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: