Healthcare Provider Details

I. General information

NPI: 1518883313
Provider Name (Legal Business Name): ELISA GIULIA GUTIERREZ-BASTONI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 28TH ST
WEST DES MOINES IA
50266-1436
US

IV. Provider business mailing address

1730 28TH ST
WEST DES MOINES IA
50266-1436
US

V. Phone/Fax

Practice location:
  • Phone: 515-276-6338
  • Fax:
Mailing address:
  • Phone: 515-276-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139245
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: