Healthcare Provider Details

I. General information

NPI: 1174581128
Provider Name (Legal Business Name): ROBERT C GUTIERREZ MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 WELLESLEY AVE
LOS ANGELES CA
90025-3633
US

IV. Provider business mailing address

1741 WELLESLEY AVE
LOS ANGELES CA
90025-3633
US

V. Phone/Fax

Practice location:
  • Phone: 702-940-4263
  • Fax: 702-940-4265
Mailing address:
  • Phone: 702-940-4263
  • Fax: 702-940-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number9799
License Number StateNV

VIII. Authorized Official

Name: ROBERT C GUTIERREZ
Title or Position: OWNER
Credential: MD
Phone: 702-940-4263