Provider Demographics
NPI:1104022581
Name:GUTIERREZ, ERASTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERASTO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2913
Mailing Address - Country:US
Mailing Address - Phone:909-729-5079
Mailing Address - Fax:909-729-5081
Practice Address - Street 1:1749 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2913
Practice Address - Country:US
Practice Address - Phone:909-729-5079
Practice Address - Fax:909-729-5081
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-00777207Q00000X
NMRS20070324207Q00000X
CAA110685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine