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General NPI Number Information
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NPI Number | 1336073980
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Entity Type | Individual
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Provider Name | ROBERTO GUTIERREZ
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Gender | Male
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 3785 SW 5TH DR
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City | GRESHAM
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State | OR
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Zip | 97030-6419
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Country | US
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Telephone | 619-678-3061
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Fax | 971-274-2157
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Provider Business Mailing Address
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Address Line | 3785 SW 5TH DR
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City | GRESHAM
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State | OR
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Zip | 97030-6419
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Country | US
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Telephone | 619-678-3061
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Fax | 971-274-2157
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 11627
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License Number State | OR
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