Provider Demographics
NPI:1033668025
Name:GUTIERREZ, ELVIRA (LVN)
Entity Type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 TUPELO DR
Mailing Address - Street 2:17
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1768
Mailing Address - Country:US
Mailing Address - Phone:916-862-0019
Mailing Address - Fax:
Practice Address - Street 1:6413 TUPELO DR
Practice Address - Street 2:17
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1768
Practice Address - Country:US
Practice Address - Phone:916-862-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283845164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse