Healthcare Provider Details

I. General information

NPI: 1548091705
Provider Name (Legal Business Name): KLARA CECILIA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FORD ST
OAKLAND CA
94601-2114
US

IV. Provider business mailing address

495 JACKSON ST
OAKLAND CA
94607-4329
US

V. Phone/Fax

Practice location:
  • Phone: 510-301-6486
  • Fax:
Mailing address:
  • Phone: 510-301-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW139871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: