Provider Demographics
NPI:1770993123
Name:GUTIERREZ, BLANCA
Entity type:Individual
Prefix:
First Name:BLANCA
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:PO BOX 50423
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-0423
Mailing Address - Country:US
Mailing Address - Phone:866-832-3015
Mailing Address - Fax:775-737-4332
Practice Address - Street 1:4860 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2863
Practice Address - Country:US
Practice Address - Phone:866-832-3015
Practice Address - Fax:775-737-4332
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst