Healthcare Provider Details

I. General information

NPI: 1902539992
Provider Name (Legal Business Name): ROSALINA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 OTIS ST
SOUTH GATE CA
90280-4931
US

IV. Provider business mailing address

9715 OTIS ST
SOUTH GATE CA
90280-4997
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-1198
  • Fax: 323-566-0760
Mailing address:
  • Phone: 323-566-1198
  • Fax: 323-566-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: