Healthcare Provider Details

I. General information

NPI: 1215517891
Provider Name (Legal Business Name): CHRISTINE GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 W LAS POSITAS BLVD STE 320
PLEASANTON CA
94588-5808
US

IV. Provider business mailing address

5565 W LAS POSITAS BLVD STE 320
PLEASANTON CA
94588-5808
US

V. Phone/Fax

Practice location:
  • Phone: 925-278-7095
  • Fax:
Mailing address:
  • Phone: 925-278-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: