MEDICARE: JUANA 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	225700000X	Massage Therapist	99099	CA

General Provider Information

NPI Number	:	1821887597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA GUTIERREZ

Provider Business Mailing Address
First Line	:	797 CAMPUS WAY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3822
Country	:	US
Telephone Number	:	909-708-2966
Fax Number	:

Provider Business Practice Location Address
First Line	:	797 CAMPUS WAY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3822
Country	:	US
Telephone Number	:	909-708-2966
Fax Number	:

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

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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Directions to “ JUANA GUTIERREZ ” Practice Location

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