Provider Demographics
NPI:1922777689
Name:GUTIERREZ, ELLIOT MAGDALENO
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:MAGDALENO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3840
Mailing Address - Country:US
Mailing Address - Phone:831-636-4000
Mailing Address - Fax:
Practice Address - Street 1:481 4TH ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3840
Practice Address - Country:US
Practice Address - Phone:831-636-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management