Healthcare Provider Details

I. General information

NPI: 1407330715
Provider Name (Legal Business Name): TREASURE GUTIERREZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 E FOOTHILL BLVD # 119
PASADENA CA
91107-3439
US

IV. Provider business mailing address

500 S LAKE ST APT 202
LOS ANGELES CA
90057-2769
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-2261
  • Fax:
Mailing address:
  • Phone: 213-905-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberASW84238
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW84238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: