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General NPI Number Information
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NPI Number | 1144762774
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Entity Type | Individual
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Provider Name | JUAN GUTIERREZ
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Gender | Male
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 4080 LOMA VISTA RD STE F
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City | VENTURA
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State | CA
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Zip | 93003-1811
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Country | US
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Telephone | 805-667-2841
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 WILLIAMS DR STE 150
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City | OXNARD
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State | CA
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Zip | 93036-2612
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Country | US
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Telephone | 805-981-8460
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 123130
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License Number State | CA
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