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General NPI Number Information
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NPI Number | 1932578432
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Entity Type | Individual
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Provider Name | JOSE DE JESUS GUTIERREZ
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Gender | Male
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 410 W FALLBROOK AVE STE 105
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City | FRESNO
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State | CA
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Zip | 93711-6191
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Country | US
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Telephone | 559-472-0501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3404
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City | VISALIA
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State | CA
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Zip | 93278-3404
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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 |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 145939
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License Number State | CA
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