Provider Demographics
NPI:1184857971
Name:GUTIERREZ, VANESSA
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
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 1:704 S EDWARDS CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2217
Mailing Address - Country:US
Mailing Address - Phone:559-623-5408
Mailing Address - Fax:
Practice Address - Street 1:220 N LOCUST ST
Practice Address - Street 2:220 N. LOCUST
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4946
Practice Address - Country:US
Practice Address - Phone:559-627-1385
Practice Address - Fax:559-636-2105
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5478OtherDRUG MEDICAL