Provider Demographics
NPI:1962640433
Name:GUTIERREZ, MARIA ELENA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
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 1:440 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3776
Mailing Address - Country:US
Mailing Address - Phone:626-447-5126
Mailing Address - Fax:
Practice Address - Street 1:440 E HUNTINGTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3776
Practice Address - Country:US
Practice Address - Phone:626-447-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60819126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant