MEDICARE: DR. MALINTZE GUTIERREZ D.O.

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	2083P0901X	Public Health & General Preventive Medicine Physician	2OA 11099	CA

General Provider Information

NPI Number	:	1689837031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALINTZE GUTIERREZ D.O.

Provider Business Mailing Address
First Line	:	302 WASHINGTON ST STE 146
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5575 RUFFIN RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1361
Country	:	US
Telephone Number	:	858-277-2744
Fax Number	:

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	12/27/2017

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