Provider Demographics
NPI:1124023254
Name:GUTIERREZ, RIGOBERTO
Entity Type:Individual
Prefix:
First Name:RIGOBERTO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-0010
Mailing Address - Country:US
Mailing Address - Phone:530-538-9410
Mailing Address - Fax:530-538-9411
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:STE 370
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6136
Practice Address - Country:US
Practice Address - Phone:530-538-9410
Practice Address - Fax:530-538-9411
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160056751OtherMEDICARE RAILROAD #
CA00G767230Medicaid
058913Medicare Oscar/Certification
CA00G767230Medicare ID - Type Unspecified
160056751OtherMEDICARE RAILROAD #