MEDICARE: MS. PATRICIA 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	1041C0700X	Clinical Social Worker	101535	CA

General Provider Information

NPI Number	:	1457619363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA GUTIERREZ

Provider Business Mailing Address
First Line	:	2309 DALY ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8929 S SEPULVEDA BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3643
Country	:	US
Telephone Number	:	626-991-3893
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/11/2024

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