Healthcare Provider Details

I. General information

NPI: 1023737848
Provider Name (Legal Business Name): LUCIA GUTIERREZ MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESI GUTIERREZ MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST STE 500
SAN FRANCISCO CA
94115-3495
US

IV. Provider business mailing address

18507 LAKESHORE DR
LUTZ FL
33549-3826
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7700
  • Fax:
Mailing address:
  • Phone: 813-361-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: