Provider Demographics
NPI:1497112155
Name:GUTIERREZ, REVECA L
Entity Type:Individual
Prefix:MISS
First Name:REVECA
Middle Name:L
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 BIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2534
Mailing Address - Country:US
Mailing Address - Phone:510-364-3606
Mailing Address - Fax:
Practice Address - Street 1:5865 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-2534
Practice Address - Country:US
Practice Address - Phone:510-364-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor