Provider Demographics
NPI:1043400609
Name:GUTIERREZ, KARYNN MONIQUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARYNN
Middle Name:MONIQUE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E STUART AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3575
Mailing Address - Country:US
Mailing Address - Phone:909-307-5208
Mailing Address - Fax:909-307-5254
Practice Address - Street 1:760 E STUART AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3575
Practice Address - Country:US
Practice Address - Phone:909-307-5208
Practice Address - Fax:909-307-5254
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health