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General NPI Number Information
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NPI Number | 1275854879
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Entity Type | Individual
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Provider Name | FERNANDO JOSE GUTIERREZ ED.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 2810 E DEL MAR BLVD 11A
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City | PASADENA
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State | CA
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Zip | 91107-4321
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Country | US
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Telephone | 818-457-0376
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Fax | 818-824-3442
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Provider Business Mailing Address
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Address Line | PO BOX 70160
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City | PASADENA
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State | CA
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Zip | 91117-7160
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Country | US
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Telephone | 818-457-0376
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Fax | 818-824-3442
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY8801
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License Number State | CA
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