Provider Demographics
NPI:1578014023
Name:GUTIERREZ, FERNANDO
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
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 1:7341 S JAMES RD
Mailing Address - Street 2:
Mailing Address - City:TRANQUILLITY
Mailing Address - State:CA
Mailing Address - Zip Code:93668-9720
Mailing Address - Country:US
Mailing Address - Phone:559-408-1339
Mailing Address - Fax:
Practice Address - Street 1:7341 S JAMES RD
Practice Address - Street 2:
Practice Address - City:TRANQUILLITY
Practice Address - State:CA
Practice Address - Zip Code:93668-9720
Practice Address - Country:US
Practice Address - Phone:559-408-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA208312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer