Provider Demographics
NPI:1639531510
Name:GUTIERREZ, JO CHERRIBEL (LVN)
Entity Type:Individual
Prefix:
First Name:JO CHERRIBEL
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17040 VIA ALAMITOS
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-2822
Mailing Address - Country:US
Mailing Address - Phone:510-329-1569
Mailing Address - Fax:
Practice Address - Street 1:5674 STONERIDGE DR STE 207
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8592
Practice Address - Country:US
Practice Address - Phone:925-520-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA218924164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse