Provider Demographics
NPI:1235373895
Name:GUTIERREZ, ROSA SARAI
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:SARAI
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 1:505 SANTA CLARA ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5922
Mailing Address - Country:US
Mailing Address - Phone:707-648-5230
Mailing Address - Fax:707-648-5212
Practice Address - Street 1:505 SANTA CLARA ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5922
Practice Address - Country:US
Practice Address - Phone:707-648-5230
Practice Address - Fax:707-648-5212
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0298092OtherMEDICAL