Provider Demographics
NPI:1114618188
Name:GUTIERREZ, TARINA
Entity Type:Individual
Prefix:MRS
First Name:TARINA
Middle Name:
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 1:15374 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2839
Mailing Address - Country:US
Mailing Address - Phone:760-553-6973
Mailing Address - Fax:
Practice Address - Street 1:14344 CAJON AVE STE 102
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-4301
Practice Address - Country:US
Practice Address - Phone:760-243-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Yes172V00000XOther Service ProvidersCommunity Health Worker