Healthcare Provider Details

I. General information

NPI: 1154505196
Provider Name (Legal Business Name): MS. CAROLYN BENITEZ GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N LOCUST 220 N LOCUST
VISALIA CA
93291-4946
US

IV. Provider business mailing address

220 N LOCUST 220 LOCUST
VISALIA CA
93291-4946
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1385
  • Fax: 559-636-2105
Mailing address:
  • Phone: 559-627-1385
  • Fax: 559-636-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberN4152296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: