Provider Demographics
NPI:1932316767
Name:GUTIERREZ, RICHARD RAYMOND (CAS CERTIFIED)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RAYMOND
Last Name:GUTIERREZ
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Gender:M
Credentials:CAS CERTIFIED
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Mailing Address - Street 1:1365 N JOHNSON AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1676
Mailing Address - Country:US
Mailing Address - Phone:619-441-2493
Mailing Address - Fax:619-441-2486
Practice Address - Street 1:1365 N JOHNSON AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1676
Practice Address - Country:US
Practice Address - Phone:619-441-2493
Practice Address - Fax:619-441-2486
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA01-046508101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)