Provider Demographics
NPI:1265742365
Name:GUTIERREZ, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
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 1:209 N AVE 49
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3801
Mailing Address - Country:US
Mailing Address - Phone:323-344-2996
Mailing Address - Fax:
Practice Address - Street 1:13177 RAMONA BLVD
Practice Address - Street 2:STE.C
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3855
Practice Address - Country:US
Practice Address - Phone:626-960-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner