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General NPI Number Information
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NPI Number | 1912026642
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Entity Type | Individual
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Provider Name | SALOME R. GUTIERREZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 79301 COUNTRY CLUB DR STE 102
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City | BERMUDA DUNES
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State | CA
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Zip | 92203-1250
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Country | US
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Telephone | 760-333-8393
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Fax | 760-347-2904
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Provider Business Mailing Address
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Address Line | 79301 COUNTRY CLUB DR STE 102
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City | BERMUDA DUNES
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State | CA
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Zip | 92203-1250
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Country | US
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Telephone | 760-333-8393
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Fax | 760-347-2904
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY31929
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-31459
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License Number State | CA
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