Healthcare Provider Details

I. General information

NPI: 1881557783
Provider Name (Legal Business Name): RIGOBERTO R GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12204 CLARETTA ST # 601B
SYLMAR CA
91342-6052
US

IV. Provider business mailing address

434 SW COLLEGE ST APT 601B
PORTLAND OR
97201-5268
US

V. Phone/Fax

Practice location:
  • Phone: 562-489-5332
  • Fax:
Mailing address:
  • Phone: 562-489-5332
  • Fax: 562-489-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number88505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: