MEDICARE: JUDY GUTIERREZ NP

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	363LP2300X	Primary Care Nurse Practitioner	95022629	CA

General Provider Information

NPI Number	:	1801599584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY GUTIERREZ NP

Provider Business Mailing Address
First Line	:	9640 VENICE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2626
Country	:	US
Telephone Number	:	310-905-4581
Fax Number	:

Provider Business Practice Location Address
First Line	:	9640 VENICE BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2626
Country	:	US
Telephone Number	:	310-963-0365
Fax Number	:	310-496-3101

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

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/27/2024

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