Provider Demographics
NPI:1346909413
Name:GUTIERREZ, NANCY G
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:G
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 1:900 E GILBERT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0936
Mailing Address - Country:US
Mailing Address - Phone:909-601-0915
Mailing Address - Fax:909-387-7047
Practice Address - Street 1:900 E GILBERT ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0936
Practice Address - Country:US
Practice Address - Phone:909-601-0915
Practice Address - Fax:909-387-7047
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator