Provider Demographics
NPI:1922022821
Name:GUTIERREZ, ANTONIO (MA)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SAINT JAMES
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1918
Mailing Address - Country:US
Mailing Address - Phone:949-679-7325
Mailing Address - Fax:
Practice Address - Street 1:217 W CERRITOS AVE
Practice Address - Street 2:BUILDING # 8
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6549
Practice Address - Country:US
Practice Address - Phone:714-254-8473
Practice Address - Fax:714-254-8480
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist