Healthcare Provider Details

I. General information

NPI: 1164172060
Provider Name (Legal Business Name): YASMIN GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

13654 MONTEVERDE DR
CHINO HILLS CA
91709-1358
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-3205
  • Fax:
Mailing address:
  • Phone: 909-631-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA187262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: