Provider Demographics
NPI:1326314576
Name:ROLANDO GUTIERREZ M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROLANDO GUTIERREZ M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-664-2073
Mailing Address - Street 1:4314 W VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1334
Mailing Address - Country:US
Mailing Address - Phone:818-843-6611
Mailing Address - Fax:818-843-6656
Practice Address - Street 1:4314 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1334
Practice Address - Country:US
Practice Address - Phone:818-843-6611
Practice Address - Fax:818-843-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93879173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty