Provider Demographics
NPI:1518551480
Name:GUTIERREZ, DANIEL NATHAN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:NATHAN
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 N TUSTIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7875
Mailing Address - Country:US
Mailing Address - Phone:855-581-0100
Mailing Address - Fax:855-329-3973
Practice Address - Street 1:2080 N TUSTIN AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7875
Practice Address - Country:US
Practice Address - Phone:855-581-0100
Practice Address - Fax:855-329-3973
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician