Provider Demographics
NPI:1770113342
Name:MANUEL, SHAUN MARVIN GUTIERREZ (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAUN MARVIN
Middle Name:GUTIERREZ
Last Name:MANUEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 SAGUARO DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-4479
Mailing Address - Country:US
Mailing Address - Phone:510-432-5825
Mailing Address - Fax:
Practice Address - Street 1:602 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-1927
Practice Address - Country:US
Practice Address - Phone:831-784-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist