Healthcare Provider Details

I. General information

NPI: 1841164530
Provider Name (Legal Business Name): CRISTIAN GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 S LILAC AVE
RIALTO CA
92376-7443
US

IV. Provider business mailing address

1264 S LILAC AVE
RIALTO CA
92376-7443
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-5876
  • Fax:
Mailing address:
  • Phone: 909-583-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: