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General NPI Number Information
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NPI Number | 1902391717
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Entity Type | Individual
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Provider Name | JACOB JAMES GUTIERREZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 631A MAPLE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90014-2211
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Country | US
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Telephone | 213-673-3049
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 920
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City | ARTESIA
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State | CA
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Zip | 90702-0920
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Country | US
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Telephone | 213-673-3084
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A163989
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License Number State | CA
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