Provider Demographics
NPI:1588228928
Name:GUTIERREZ, COREEN ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:COREEN
Middle Name:ELIZABETH
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BATTERY ST STE 802
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5522
Mailing Address - Country:US
Mailing Address - Phone:415-855-3112
Mailing Address - Fax:
Practice Address - Street 1:22 BATTERY ST STE 802
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5522
Practice Address - Country:US
Practice Address - Phone:415-855-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist