{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MELISSA GUTIERREZ MD, CORP.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1112 OCEAN PARK BLVD APT C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA MONICA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90405-4756",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "150 N ROBERTSON BLVD STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEVERLY HILLS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90211-2144",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "320-652-9347",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/03/2021",
"LastUpdateDate": "03/03/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUTIERREZ",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "617-894-2853",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}