Provider Demographics
NPI:1326544982
Name:GUTIERREZ, ENRIQUE JR
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25102 JEFFERSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1708
Mailing Address - Country:US
Mailing Address - Phone:951-461-1190
Mailing Address - Fax:
Practice Address - Street 1:27192 NEWPORT RD STE 1
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7387
Practice Address - Country:US
Practice Address - Phone:951-566-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant