Provider Demographics
NPI:1396832879
Name:GUTIERREZ, JUAN JOSE (BA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:JOSE
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21910 ARLINE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1211
Mailing Address - Country:US
Mailing Address - Phone:562-310-5035
Mailing Address - Fax:
Practice Address - Street 1:21910 ARLINE AVE
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1211
Practice Address - Country:US
Practice Address - Phone:562-310-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor