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NPI Code Detail

MEDICARE: VICTORIA GUTIERREZ PTA

MEDICARE: VICTORIA GUTIERREZ PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant10176CA

General Provider Information

NPI Number : 1053702605
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA GUTIERREZ PTA
Provider Business Mailing Address
First Line : 6826 DORIANA ST
Second Line : APT 19
City : SAN DIEGO
State : CA
Zip : 92139-2035
Country : US
Telephone Number : 619-646-9703
Fax Number :
Provider Business Practice Location Address
First Line : 4435 EASTGATE MALL
Second Line : STE 120
City : SAN DIEGO
State : CA
Zip : 92121-1982
Country : US
Telephone Number : 858-587-8669
Fax Number : 858-587-8675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2015
Last Update Date : 02/17/2015

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Directions to “ VICTORIA GUTIERREZ PTA” Practice Location

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