Provider Demographics
NPI:1669021713
Name:GUTIERREZ, RUBEN DANIEL (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:DANIEL
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 MIDWAY DR UNIT 501
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4560
Mailing Address - Country:US
Mailing Address - Phone:928-246-2755
Mailing Address - Fax:
Practice Address - Street 1:4141 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-393-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7069724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist