Provider Demographics
NPI:1598070773
Name:SMITH, VICTORIA GUTIERREZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:GUTIERREZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5626
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92838-0626
Mailing Address - Country:US
Mailing Address - Phone:714-615-1519
Mailing Address - Fax:
Practice Address - Street 1:1501 N HARBOR BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3811
Practice Address - Country:US
Practice Address - Phone:714-615-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23616103G00000X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth