Provider Demographics
NPI:1477560746
Name:GUTIERREZ, RONALD J (PTA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7164 JOSSLYN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3320
Mailing Address - Country:US
Mailing Address - Phone:408-988-6868
Mailing Address - Fax:408-492-9825
Practice Address - Street 1:7164 JOSSLYN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-3320
Practice Address - Country:US
Practice Address - Phone:408-988-6868
Practice Address - Fax:408-492-9825
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1324225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant