Provider Demographics
NPI:1972087021
Name:GUTIERREZ, JULIAN ENRIQUE JR
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:ENRIQUE
Last Name:GUTIERREZ
Suffix:JR
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 1:4215 TEAL ST APT B6
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-6476
Mailing Address - Country:US
Mailing Address - Phone:562-505-6034
Mailing Address - Fax:
Practice Address - Street 1:17801 INDUSTRIAL FARM RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-9599
Practice Address - Country:US
Practice Address - Phone:661-391-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA692301164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse