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General NPI Number Information
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NPI Number | 1831784669
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Entity Type | Organization
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Legal Business Name | MELISSA GUTIERREZ MD, CORP.
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 150 N ROBERTSON BLVD STE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2144
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Country | US
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Telephone | 320-652-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 OCEAN PARK BLVD APT C
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City | SANTA MONICA
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State | CA
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Zip | 90405-4756
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MELISSA MARIE GUTIERREZ
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Credential | MD
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Telephone | 617-894-2853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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