Provider Demographics
NPI:1457931222
Name:GUTIERREZ GO, PATRICK VINCENT (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:VINCENT
Last Name:GUTIERREZ GO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PATRICK-VINCENT
Other - Middle Name:GUTIERREZ
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:17234 VALLEY BLVD, BUILDING A
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10800 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3043
Practice Address - Country:US
Practice Address - Phone:760-774-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program