Healthcare Provider Details

I. General information

NPI: 1831477140
Provider Name (Legal Business Name): MARIBEL GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 E HIGHLAND AVE
PATTON CA
92369-7813
US

IV. Provider business mailing address

PO BOX 177
PATTON CA
92369-0177
US

V. Phone/Fax

Practice location:
  • Phone: 909-425-7000
  • Fax:
Mailing address:
  • Phone: 831-229-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: