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General NPI Number Information
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NPI Number | 1760646244
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Entity Type | Individual
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Provider Name | ERICK ELI GUTIERREZ D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 14305 BASELINE AVE
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City | FONTANA
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State | CA
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Zip | 92336-3631
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Country | US
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Telephone | 909-355-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 6175 OCASA DR
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City | MIRA LOMA
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State | CA
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Zip | 91752-3060
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Country | US
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Telephone | 951-323-6163
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 58864
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License Number State | CA
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