Provider Demographics
NPI:1457085003
Name:GUTIERREZ, CINDY CAROLINA (COTA/L)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:CAROLINA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 SAN JUAN CIR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2338
Mailing Address - Country:US
Mailing Address - Phone:626-733-3577
Mailing Address - Fax:
Practice Address - Street 1:222 N SUNSET AVE STE D
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2278
Practice Address - Country:US
Practice Address - Phone:626-671-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5956224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant