Provider Demographics
NPI:1275181687
Name:GUTIERREZ, GISELL AIMEE
Entity Type:Individual
Prefix:
First Name:GISELL
Middle Name:AIMEE
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 1:13751 RAYEN ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6143
Mailing Address - Country:US
Mailing Address - Phone:818-983-9994
Mailing Address - Fax:
Practice Address - Street 1:13751 RAYEN ST
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6143
Practice Address - Country:US
Practice Address - Phone:818-983-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3026240103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst