=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851643282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBEN GUTIERREZ M.A., L.M.F.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2012
-----------------------------------------------------
Last Update Date | 09/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27201 TOURNEY RD STE 201K
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-310-1525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27305 LIVE OAK RD STE A
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91384-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-310-1525
-----------------------------------------------------
Fax | 310-398-5690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT96985
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------