Provider Demographics
NPI:1982974119
Name:GUTIERREZ, OSBALDO (MSW)
Entity Type:Individual
Prefix:
First Name:OSBALDO
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MSW
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 292360
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-8360
Mailing Address - Country:US
Mailing Address - Phone:213-453-1748
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 1090
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5006
Practice Address - Country:US
Practice Address - Phone:213-453-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19779104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker