Provider Information for 1063899730
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MAYRA GUTIERREZ
Sex: Female
NPI: 1063899730
Last Updated: 2024-11-07
Certification Date: 2024-11-07
Certification Date: 2024-11-07
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1063899730 | ||||||||||||
| Enumeration Date | 2015-05-01 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 900 E WARDLOW RD LONG BEACH, CA 90807-4630 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 17707 STUDEBAKER RD STE 208 CERRITOS, CA 90703-2640 United States Phone: 562-402-0677 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 900 E WARDLOW RD | ||||||||||||
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