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General NPI Number Information
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NPI Number | 1770015505
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Entity Type | Individual
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Provider Name | RICARDO DOUGLAS GUTIERREZ
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Gender | Male
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 15141 WHITTIER BLVD STE 350
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City | WHITTIER
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State | CA
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Zip | 90603-2169
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Country | US
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Telephone | 562-698-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 133 E BROOKDALE PL UNIT 133B
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City | FULLERTON
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State | CA
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Zip | 92832-1549
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Country | US
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Telephone | 253-225-5199
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A160483
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License Number State | CA
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