Provider Demographics
NPI:1801599584
Name:GUTIERREZ, JUDY (NP)
Entity type:Individual
Prefix:
First Name:JUDY
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 1:9640 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2626
Mailing Address - Country:US
Mailing Address - Phone:310-905-4581
Mailing Address - Fax:
Practice Address - Street 1:9640 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2626
Practice Address - Country:US
Practice Address - Phone:310-963-0365
Practice Address - Fax:310-496-3101
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022629363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care