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General NPI Number Information
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NPI Number | 1336013630
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Entity Type | Individual
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Provider Name | JOSE ANGEL GUTIERREZ BA
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Gender | Male
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 3200 E EISENHOWER PKWY
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City | ANN ARBOR
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State | MI
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Zip | 48108-3231
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Country | US
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Telephone | 734-210-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 7436 BANCROFT CT
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City | CANTON
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State | MI
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Zip | 48187-2362
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Country | US
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Telephone | 734-707-5595
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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