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General NPI Number Information
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NPI Number | 1366951592
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Entity Type | Individual
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Provider Name | MARIO GUTIERREZ
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Gender | Male
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 2060 W WHISPERING WIND DR STE 264
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City | PHOENIX
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State | AZ
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Zip | 85085-2869
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Country | US
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Telephone | 602-616-5423
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Fax |
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Provider Business Mailing Address
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Address Line | 11423 N 112TH AVE
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City | YOUNGTOWN
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State | AZ
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Zip | 85363-1558
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Country | US
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Telephone | 602-616-5423
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-15863
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License Number State | AZ
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