Healthcare Provider Details

I. General information

NPI: 1063311587
Provider Name (Legal Business Name): JASMINE GUTIERREZ PPS SCHOOL PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16820 VIA PAMPLONA
MORENO VALLEY CA
92551-2146
US

IV. Provider business mailing address

975 MORGAN ST
PERRIS CA
92571-3103
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-8530
  • Fax:
Mailing address:
  • Phone: 951-940-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: