Provider Demographics
NPI:1457329583
Name:GUTIERREZ, VINCENT CLAUDIO (DPT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:CLAUDIO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1141
Mailing Address - Country:US
Mailing Address - Phone:408-248-6886
Mailing Address - Fax:408-248-4923
Practice Address - Street 1:2145 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1141
Practice Address - Country:US
Practice Address - Phone:408-248-6886
Practice Address - Fax:408-248-4923
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT271021Medicare UPIN