Provider Demographics
NPI:1871026740
Name:GUTIERREZ, MONSHERAD CLAUDETTE
Entity Type:Individual
Prefix:
First Name:MONSHERAD
Middle Name:CLAUDETTE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 NW SCHMIDT WAY APT 111
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4775
Mailing Address - Country:US
Mailing Address - Phone:702-569-5892
Mailing Address - Fax:
Practice Address - Street 1:2020 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2345
Practice Address - Country:US
Practice Address - Phone:503-233-6121
Practice Address - Fax:503-233-6126
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician