Healthcare Provider Details

I. General information

NPI: 1801092440
Provider Name (Legal Business Name): JULIO A GUTIERREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W 3RD ST STE 5000
LOS ANGELES CA
90057
US

IV. Provider business mailing address

2200 W 3RD ST STE 200
LOS ANGELES CA
90057-1935
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-5551
  • Fax:
Mailing address:
  • Phone: 213-484-7267
  • Fax: 213-484-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA107985
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA107985
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA107985
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberA107985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: