Healthcare Provider Details

I. General information

NPI: 1104749670
Provider Name (Legal Business Name): GERARDO MUNOZ-GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAGNOLIA AVE
LONG BEACH CA
90806-4521
US

IV. Provider business mailing address

2042 E LUCIEN ST
COMPTON CA
90222-2405
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-1868
  • Fax:
Mailing address:
  • Phone: 323-244-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-VEOGBC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: