Provider Demographics
NPI:1841054103
Name:GUTIERREZ, JOANE (PA)
Entity type:Individual
Prefix:
First Name:JOANE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 SPAHN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1240
Mailing Address - Country:US
Mailing Address - Phone:669-213-9625
Mailing Address - Fax:
Practice Address - Street 1:408 S BEACH BLVD STE 211
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1869
Practice Address - Country:US
Practice Address - Phone:669-213-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64031207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology