Provider Demographics
NPI:1346989415
Name:GUTIERREZ GASCA, STEPHANIE (MS, GC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GUTIERREZ GASCA
Suffix:
Gender:F
Credentials:MS, GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 ARLINGTON AVE STE E202
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3923
Mailing Address - Country:US
Mailing Address - Phone:951-683-4675
Mailing Address - Fax:951-683-1148
Practice Address - Street 1:3637 ARLINGTON AVE STE E202
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3923
Practice Address - Country:US
Practice Address - Phone:951-683-4675
Practice Address - Fax:951-683-1148
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS