Healthcare Provider Details

I. General information

NPI: 1518961127
Provider Name (Legal Business Name): SUSAN E GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK PL SUITE 120
SAN RAMON CA
94583-4460
US

IV. Provider business mailing address

100 PARK PL SUITE 120
SAN RAMON CA
94583-4460
US

V. Phone/Fax

Practice location:
  • Phone: 925-806-0757
  • Fax: 925-277-1557
Mailing address:
  • Phone: 925-806-0757
  • Fax: 925-277-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA86541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: