Provider Demographics
NPI:1376910174
Name:GUTIERREZ VASQUEZ, GENEVA D (OTD)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:D
Last Name:GUTIERREZ VASQUEZ
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2715
Mailing Address - Country:US
Mailing Address - Phone:800-707-5768
Mailing Address - Fax:888-723-3351
Practice Address - Street 1:4021 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2715
Practice Address - Country:US
Practice Address - Phone:800-707-5768
Practice Address - Fax:888-723-3351
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist