Healthcare Provider Details

I. General information

NPI: 1457077851
Provider Name (Legal Business Name): ERWIN C GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43322 GINGHAM AVE
LANCASTER CA
93535-4576
US

IV. Provider business mailing address

2332 BAVARIAN AVE
ROSAMOND CA
93560-6749
US

V. Phone/Fax

Practice location:
  • Phone: 661-874-4050
  • Fax:
Mailing address:
  • Phone: 661-974-1076
  • Fax: 661-522-7684

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: