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General NPI Number Information
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NPI Number | 1760467963
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Entity Type | Individual
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Provider Name | CHARLES E GUTIERREZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 8401 DATAPOINT DR STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5904
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Country | US
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Telephone | 210-354-1186
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Fax | 210-354-1187
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Provider Business Mailing Address
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Address Line | 8401 DATAPOINT DR STE301
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5904
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Country | US
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Telephone | 210-354-1186
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Fax | 210-354-1187
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31016
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License Number State | TX
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