Provider Demographics
NPI:1891039863
Name:GUTIERREZ, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
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 1:2261 ELM ST
Mailing Address - Street 2:BLDG. A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3721
Mailing Address - Country:US
Mailing Address - Phone:707-299-1760
Mailing Address - Fax:707-299-2199
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:BLDG. A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-299-1760
Practice Address - Fax:707-299-2199
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program