Healthcare Provider Details

I. General information

NPI: 1790630275
Provider Name (Legal Business Name): OSCAR GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE FL 17
LOS ANGELES CA
90017-5105
US

IV. Provider business mailing address

333 S BEAUDRY AVE FL 17
LOS ANGELES CA
90017-5105
US

V. Phone/Fax

Practice location:
  • Phone: 818-445-0924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT10576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: