Provider Demographics
NPI:1366040891
Name:GUTIERREZ, ANALYSE MONIQUE
Entity Type:Individual
Prefix:
First Name:ANALYSE
Middle Name:MONIQUE
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 1:14082 ALMOND GROVE CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8563
Mailing Address - Country:US
Mailing Address - Phone:562-200-2694
Mailing Address - Fax:
Practice Address - Street 1:14082 ALMOND GROVE CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8563
Practice Address - Country:US
Practice Address - Phone:562-200-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician