Provider Demographics
NPI:1659694487
Name:GUTIERREZ, ANDREW JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACOB
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 5TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1443
Mailing Address - Country:US
Mailing Address - Phone:310-993-8482
Mailing Address - Fax:
Practice Address - Street 1:2211 CORINTH AVE STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1622
Practice Address - Country:US
Practice Address - Phone:310-742-6261
Practice Address - Fax:310-478-8521
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor