Provider Demographics
NPI:1689974917
Name:GUTIERREZ, RICK DANIEL JR (BCBA)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:DANIEL
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:BCBA
Other - Prefix:MR
Other - First Name:RICCARDO
Other - Middle Name:DANIEL
Other - Last Name:GUTIERREZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:7673 WIMBLETON CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6695
Mailing Address - Country:US
Mailing Address - Phone:909-484-2848
Mailing Address - Fax:909-484-7257
Practice Address - Street 1:7673 WIMBLETON CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6695
Practice Address - Country:US
Practice Address - Phone:909-484-2848
Practice Address - Fax:909-484-7257
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-05-2251103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst