MEDICARE: PROF. MARY A GUTIERREZ PHARM.D.

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	1835P1300X	Psychiatric Pharmacist	41258	CA

General Provider Information

NPI Number	:	1417948423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. MARY A GUTIERREZ PHARM.D.

Provider Business Mailing Address
First Line	:	UNIVERSITY OF SOUTHERN CALIFORNIA SCH OF PHARMACY
Second Line	:	1985 ZONAL AVE
City	:	LOS ANGELES
State	:	CA
Zip	:	90089
Country	:	US
Telephone Number	:	323-442-1456
Fax Number	:	323-442-1681

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF SOUTHERN CALIFORNIA SCH OF PHARMACY
Second Line	:	1985 ZONAL AVE
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	323-442-1456
Fax Number	:	323-442-1681

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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