Healthcare Provider Details

I. General information

NPI: 1457673105
Provider Name (Legal Business Name): DAVID SIMON GUTIERREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

1520 RODNEY DR APT 409
LOS ANGELES CA
90027-5327
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2450
  • Fax: 323-660-2450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: