Healthcare Provider Details

I. General information

NPI: 1699823054
Provider Name (Legal Business Name): LYNDA GUTIERREZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 CATHEDRAL OAKS RD
SANTA BARBARA CA
93110-1042
US

IV. Provider business mailing address

646 MI TIERRA LN
SANTA MARIA CA
93455-3854
US

V. Phone/Fax

Practice location:
  • Phone: 805-964-4710
  • Fax: 805-964-4712
Mailing address:
  • Phone: 805-922-0334
  • Fax: 805-922-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCREDENTIAL
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: