Healthcare Provider Details

I. General information

NPI: 1972422095
Provider Name (Legal Business Name): RICHARD GUTIERREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 SLAUSON AVE
WHITTIER CA
90606-2835
US

IV. Provider business mailing address

1045 N AZUSA AVE TRLR 144
COVINA CA
91722-2656
US

V. Phone/Fax

Practice location:
  • Phone: 562-693-5449
  • Fax: 562-693-5469
Mailing address:
  • Phone: 626-727-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: