Provider Demographics
NPI:1649424995
Name:GUTIERREZ, PATRICIA (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 ROSCOE BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4169
Mailing Address - Country:US
Mailing Address - Phone:818-734-4888
Mailing Address - Fax:818-734-4878
Practice Address - Street 1:18350 ROSCOE BLVD STE 401
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4169
Practice Address - Country:US
Practice Address - Phone:818-734-4888
Practice Address - Fax:818-734-4878
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17619OtherNURSE PRACTITIONER FURNISHING
CA613965OtherRN LICENSE