Healthcare Provider Details

I. General information

NPI: 1851264725
Provider Name (Legal Business Name): RYLEEANNE GUTIERREZ APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 10/24/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12711 VENTURA BLVD STE 420
STUDIO CITY CA
91604-2456
US

IV. Provider business mailing address

12711 VENTURA BLVD STE 420
STUDIO CITY CA
91604-2456
US

V. Phone/Fax

Practice location:
  • Phone: 213-290-0762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number19559
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: