Healthcare Provider Details

I. General information

NPI: 1326543984
Provider Name (Legal Business Name): BLANCA KATARZYNA GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WASHINGTON ST STE 300
SAN DIEGO CA
92103-2227
US

IV. Provider business mailing address

550 WASHINGTON ST STE 300
SAN DIEGO CA
92103-2227
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-5437
  • Fax: 619-243-0722
Mailing address:
  • Phone: 619-297-5437
  • Fax: 619-243-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1326543984
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036156318
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA196673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: