Healthcare Provider Details

I. General information

NPI: 1376150227
Provider Name (Legal Business Name): MS. KAREM GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 XIMENO AVE
LONG BEACH CA
90815-2850
US

IV. Provider business mailing address

8243 SANTA INEZ WAY
BUENA PARK CA
90620-3158
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-1990
  • Fax:
Mailing address:
  • Phone: 714-822-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: