Healthcare Provider Details

I. General information

NPI: 1033024955
Provider Name (Legal Business Name): ANTONIO LUIS GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S HUDSON AVE # 130
PASADENA CA
91101-3599
US

IV. Provider business mailing address

2700 E GLENOAKS BLVD
GLENDALE CA
91206-3109
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-3600
  • Fax:
Mailing address:
  • Phone: 747-257-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: