Healthcare Provider Details

I. General information

NPI: 1164464335
Provider Name (Legal Business Name): ZOE VERONICA GUTIERREZ MPT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SANTA ANA BLVD SUITE 100
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

26192 LA REAL #B
MISSION VIEJO CA
92691-2891
US

V. Phone/Fax

Practice location:
  • Phone: 714-347-0321
  • Fax:
Mailing address:
  • Phone: 949-306-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23813
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3200
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number23813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: