Healthcare Provider Details

I. General information

NPI: 1902762909
Provider Name (Legal Business Name): RICHARD GUTIERREZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE L-11
PASADENA CA
91106-2429
US

IV. Provider business mailing address

PO BOX 1081
ALHAMBRA CA
91802-1081
US

V. Phone/Fax

Practice location:
  • Phone: 626-599-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: