Healthcare Provider Details

I. General information

NPI: 1639531510
Provider Name (Legal Business Name): JO CHERRIBEL GUTIERREZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5674 STONERIDGE DR STE 207
PLEASANTON CA
94588-8592
US

IV. Provider business mailing address

17040 VIA ALAMITOS
SAN LORENZO CA
94580-2822
US

V. Phone/Fax

Practice location:
  • Phone: 925-520-0005
  • Fax:
Mailing address:
  • Phone: 510-329-1569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number218924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: