Healthcare Provider Details

I. General information

NPI: 1811886245
Provider Name (Legal Business Name): GISSELLE GUTIERREZ-ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N R ST STE 101
MADERA CA
93637-4465
US

IV. Provider business mailing address

117 N R ST STE 101
MADERA CA
93637-4465
US

V. Phone/Fax

Practice location:
  • Phone: 559-395-0450
  • Fax:
Mailing address:
  • Phone: 559-395-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: