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General NPI Number Information
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NPI Number | 1689052292
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Entity Type | Individual
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Provider Name | NICOLE MARIE GUTIERREZ M.A.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 17821 17TH ST STE 260
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City | TUSTIN
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State | CA
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Zip | 92780-2161
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Country | US
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Telephone | 714-494-9136
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Fax |
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Provider Business Mailing Address
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Address Line | 17155 NEWHOPE ST STE L
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4233
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Country | US
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Telephone | 714-494-9136
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 93806
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License Number State | CA
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