Provider Demographics
NPI:1619004520
Name:GUTIRREZ, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:GUTIRREZ
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 1:10012 NORWALK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3343
Mailing Address - Country:US
Mailing Address - Phone:562-906-1335
Mailing Address - Fax:
Practice Address - Street 1:10012 NORWALK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3343
Practice Address - Country:US
Practice Address - Phone:562-906-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health