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General NPI Number Information
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NPI Number | 1073866828
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Entity Type | Individual
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Provider Name | JOSHUA LEE GUTIERREZ L.A.C.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 1700 GREAT NECK RD
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City | COPIAGUE
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State | NY
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Zip | 11726-2723
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Country | US
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Telephone | 631-481-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 7 POPLAR RD
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City | AMITYVILLE
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State | NY
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Zip | 11701-1016
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Country | US
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Telephone | 631-481-6478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004878
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 020015
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License Number State | NY
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