Provider Demographics
NPI:1891761607
Name:GUTIERREZ, GRISELDA C (MD)
Entity Type:Individual
Prefix:DR
First Name:GRISELDA
Middle Name:C
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21840 NORMANDIE AVE
Mailing Address - Street 2:STE. 1000
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-328-5698
Mailing Address - Fax:310-328-5731
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 1000
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-328-5698
Practice Address - Fax:310-328-5731
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75163207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A751630Medicaid
CA00A751630Medicaid
CAH90276Medicare UPIN
CAWA75163AMedicare PIN
CAWA75163BMedicare PIN