Provider Demographics
NPI:1538457742
Name:GUTIERREZ-NAVARRETE, MANUEL
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:GUTIERREZ-NAVARRETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:DE JESUS
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2116 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1353
Mailing Address - Country:US
Mailing Address - Phone:323-334-9000
Mailing Address - Fax:
Practice Address - Street 1:2116 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1353
Practice Address - Country:US
Practice Address - Phone:323-334-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist