Healthcare Provider Details

I. General information

NPI: 1508330978
Provider Name (Legal Business Name): LINDSAY DAWN GUTIERREZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY DAWN TILLETT

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 N PACIFIC COAST HWY STE 130
REDONDO BEACH CA
90277-2107
US

IV. Provider business mailing address

16149 MARICOPA LN
APPLE VALLEY CA
92307-7802
US

V. Phone/Fax

Practice location:
  • Phone: 424-265-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95019212
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019212
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number674187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: