MEDICARE: MS. LAURA M GUTIERREZ PA

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	363A00000X	Physician Assistant	17170	CA
2	363A00000X	Physician Assistant	PA17170	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GR0078351	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1861550071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA M GUTIERREZ PA

Provider Business Mailing Address
First Line	:	7281 SOUTH LAND PARK DRIVE #205
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831
Country	:	US
Telephone Number	:	916-925-5506
Fax Number	:

Provider Business Practice Location Address
First Line	:	7281 SOUTH LAND PARK DRIVE #205
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831
Country	:	US
Telephone Number	:	916-925-5506
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	01/06/2022

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