Provider Demographics
NPI:1275102949
Name:GUTIERREZ PEREZ, MARISOL GUADALUPE (DC36092)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:GUADALUPE
Last Name:GUTIERREZ PEREZ
Suffix:
Gender:F
Credentials:DC36092
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S SOTO ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1303
Mailing Address - Country:US
Mailing Address - Phone:323-264-7878
Mailing Address - Fax:323-264-7879
Practice Address - Street 1:919 S SOTO ST STE 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1303
Practice Address - Country:US
Practice Address - Phone:323-264-7878
Practice Address - Fax:323-264-7879
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor