Healthcare Provider Details

I. General information

NPI: 1336055029
Provider Name (Legal Business Name): KARLA ALEXANDRA GUTIERREZ- HERNANDEZ SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 CIVIC DR STE 110 110
SOUTHFIELD MI
48076
US

IV. Provider business mailing address

20700 CIVIC DR STE 110 110
SOUTHFIELD MI
48076
US

V. Phone/Fax

Practice location:
  • Phone: 800-385-1035
  • Fax:
Mailing address:
  • Phone: 800-385-1035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: