Provider Demographics
NPI:1114241445
Name:GUTIERREZ, ALYNA CHANEL
Entity Type:Individual
Prefix:
First Name:ALYNA
Middle Name:CHANEL
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 E AVENUE J8
Mailing Address - Street 2:APT# 66
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-5663
Mailing Address - Country:US
Mailing Address - Phone:661-886-0016
Mailing Address - Fax:661-579-8394
Practice Address - Street 1:504 W.JACKMAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-726-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner