Healthcare Provider Details

I. General information

NPI: 1043080963
Provider Name (Legal Business Name): CARLA MARIELA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N EUCLID AVE
UPLAND CA
91786-6031
US

IV. Provider business mailing address

255 E REED ST
COVINA CA
91723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1864
  • Fax:
Mailing address:
  • Phone: 626-533-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: