Provider Demographics
NPI:1477108819
Name:GUTIERREZ, ANGELO (LVN)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SUNNE LN APT 204
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3610
Mailing Address - Country:US
Mailing Address - Phone:415-533-8513
Mailing Address - Fax:
Practice Address - Street 1:8001 KELOK WAY
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-2037
Practice Address - Country:US
Practice Address - Phone:925-673-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262381164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty