Provider Demographics
NPI:1629153515
Name:GUTIERREZ, GUILLERMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMINA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W 3RD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2290
Mailing Address - Country:US
Mailing Address - Phone:323-454-6940
Mailing Address - Fax:
Practice Address - Street 1:2100 W 3RD ST STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2290
Practice Address - Country:US
Practice Address - Phone:323-454-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-03-29
Deactivation Date:2022-02-03
Deactivation Code:
Reactivation Date:2022-03-18
Provider Licenses
StateLicense IDTaxonomies
CAA76597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine