Healthcare Provider Details

I. General information

NPI: 1144762774
Provider Name (Legal Business Name): JUAN GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 LOMA VISTA RD STE F
VENTURA CA
93003-1811
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 150
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-2841
  • Fax:
Mailing address:
  • Phone: 805-981-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: