Provider Demographics
NPI:1659695385
Name:GUTIERREZ, MARIA RAQUEL ESPIRITU (PTA)
Entity Type:Individual
Prefix:
First Name:MARIA RAQUEL
Middle Name:ESPIRITU
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MA. RAQUEL
Other - Middle Name:ESPIRITU
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:22520 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2705
Mailing Address - Country:US
Mailing Address - Phone:310-326-9131
Mailing Address - Fax:
Practice Address - Street 1:22520 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2705
Practice Address - Country:US
Practice Address - Phone:310-326-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8340225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant