Healthcare Provider Details

I. General information

NPI: 1720745144
Provider Name (Legal Business Name): ALEXANDRIA A GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CHICAGO AVE STE B
RIVERSIDE CA
92507-2366
US

IV. Provider business mailing address

145 S VAIL AVE
MONTEBELLO CA
90640-4547
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax: 888-542-4042
Mailing address:
  • Phone: 562-373-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: