Provider Demographics
NPI:1992396378
Name:GUTIERREZ, EDUARDO LUIS
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:LUIS
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 1:9332 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5610
Mailing Address - Country:US
Mailing Address - Phone:562-556-3871
Mailing Address - Fax:
Practice Address - Street 1:4952 WARNER AVE STE 300
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-5506
Practice Address - Country:US
Practice Address - Phone:877-910-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician