MEDICARE: HAYLIE GUTIERREZ

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
1	374J00000X	Doula

General Provider Information

NPI Number	:	1295424562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLIE GUTIERREZ

Provider Business Mailing Address
First Line	:	23315 CONTINENTAL DR
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-7748
Country	:	US
Telephone Number	:	951-200-5532
Fax Number	:

Provider Business Practice Location Address
First Line	:	23315 CONTINENTAL DR
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-7748
Country	:	US
Telephone Number	:	626-483-3985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/13/2026

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