Provider Demographics
NPI:1518961127
Name:GUTIERREZ, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PARK PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4460
Mailing Address - Country:US
Mailing Address - Phone:925-806-0757
Mailing Address - Fax:925-277-1557
Practice Address - Street 1:100 PARK PL
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4460
Practice Address - Country:US
Practice Address - Phone:925-806-0757
Practice Address - Fax:925-277-1557
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2021-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA86541208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI27817Medicare UPIN
CA00A865410Medicare ID - Type Unspecified