Healthcare Provider Details

I. General information

NPI: 1578896791
Provider Name (Legal Business Name): MR. ALFONSO GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 E VINEYARD AVE
OXNARD CA
93036-1013
US

IV. Provider business mailing address

4333 E VINEYARD AVE
OXNARD CA
93036-1013
US

V. Phone/Fax

Practice location:
  • Phone: 805-607-0078
  • Fax:
Mailing address:
  • Phone: 805-607-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW74659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: