Provider Demographics
NPI:1194864256
Name:GUTIERREZ-LOPEZ, LETICIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:GUTIERREZ-LOPEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 TELEGRAPH RD
Mailing Address - Street 2:BUILDING G
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3675
Mailing Address - Country:US
Mailing Address - Phone:626-255-3955
Mailing Address - Fax:562-942-9789
Practice Address - Street 1:11731 TELEGRAPH RD
Practice Address - Street 2:BUILDING G
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3675
Practice Address - Country:US
Practice Address - Phone:626-255-3955
Practice Address - Fax:562-942-9789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical