Healthcare Provider Details

I. General information

NPI: 1235660911
Provider Name (Legal Business Name): SUSAN GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 6
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

550 16TH ST FL 4
SAN FRANCISCO CA
94158-2604
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-3243
  • Fax: 415-353-2528
Mailing address:
  • Phone: 415-502-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA172706
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA172706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: